MEDICAL BILLING AUDITING METHOD AND SYSTEM

• US 20080052128A1
• Filed: 10/30/2007
• Published: 02/28/2008
• Est. Priority Date: 07/28/2005
• Status: Active Grant

• Current Assignee: Beraja IP LLC
• Original Assignee: IBEZA, LLC
• Inventors: Beraja, Victor, Beraja, Esther, Beraja, Roberto
• Granted Patent: US 8,010,384 B2
• Time in Patent Office: Days
• US Class Current: 705/3
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
• CPC Class Codes: G16H 70/20 relating to practices or guidelines

Abstract

A method for assessing billing compliance of a medical related decision may include receiving medical related information relating to the medical related decision and applying at least one rule to the medical related information. The method may also include auditing the medical related decision for compliance with the at least one rule and providing results of the audit.

Claims

1. A method for assessing billing compliance of a medical related decision, the method comprising:

receiving medical related information relating to the medical related decision;

applying at least one rule to the medical related information;

auditing the medical related decision for compliance with the at least one rule; and

providing results of the audit.

2. A method according to claim 1 further comprising notifying an insurance company of patient treatment;

and automatically auditing the selected medical treatment so that an insurance standard is verifiable and so that payment form the insurance company is automatically made upon verification.

3. A method according to claim 1 wherein the medical related information includes at least one selected from the group consisting of medication information, insurance information, affordability information, and medication alternative information.

4. A method according to claim 1 wherein the medical related decision includes at least one selected from a group consisting of providing a prescribed medication, obtaining a medical test, and recommending a medical procedure.

5. A method according to claim 1 further comprising:

making a billing related medical decision;

applying the at least one rule to the billing related medical decision; and

auditing the billing related decision for compliance with the at least one rule.

6. A method according to claim 4 wherein the billing related decision includes insurance reimbursement.

7. A method according to claim 4 wherein auditing compliance of the billing related decision is automated.

8. A method according to claim 7 wherein auditing compliance of the insurance reimbursement is automated.

9. A method for assessing billing compliance of a medical related decision, the method comprising:

receiving medical related information relating to the medical related decision, the medical related information including at least one selected from the group consisting of medication information, insurance information, affordability information, and medication alternative information;

making a billing related medical decision;

applying at least one rule to the billing related medical decision;

auditing the selected medical treatment so that compliance with the rule is verified and so that payment from the insurance company is automatically made upon verification.

10. A method according to claim 9 further comprising providing results of the audit.

11. A method according to claim 9 wherein the medical related decision includes at least one selected from a group consisting of providing a prescribed medication, obtaining a medical test, and recommending a medical procedure.

12. A method according to claim 9 wherein the medical related information is at least one selected from the group consisting of clinical information, patient history information, patient physical examination information, laboratory and diagnostic testing information, and diagnosis and procedure information.

13. A method according to claim 9 wherein auditing compliance of the billing related decision is automated.

14. A method according to claim 9 wherein the billing related decision includes insurance reimbursement.

15. A method according to claim 14 wherein auditing compliance of the insurance reimbursement is automated.

17. A system according to claim 15 wherein an insurance company is notified of patient treatment;

and wherein the auditing system automatically audits the selected medical treatment so that an insurance standard is verifiable and so that payment form the insurance company is automatically made upon verification.

18. A system according to claim 15 wherein the medical related information includes at least one selected from the group consisting of medication information, insurance information, affordability information, and medication alternative information.

19. A system according to claim 15 wherein the medical related decision includes at least one selected from a group consisting of providing a prescribed medication, obtaining a medical test, and recommending a medical procedure.

20. A system according to claim 15 wherein at least one of the plurality of rules is applied to a billing related medical decision, and wherein the auditing system audits the billing related decision for compliance with the at least one rule.

21. A system according to claim 19 wherein the billing related decision includes insurance reimbursement.

22. A method according to claim 19 wherein the auditing system that audits compliance of the billing related decision and is automated.

23. A system according to claim 20 wherein the auditing system that compliance of the insurance reimbursement is automated.

16. A billing compliance assessment system comprising:

at least one user interface;

a plurality of rules stored on a memory and accessible using said at least one user interface; and

an auditing system in communication with said plurality of rules;

wherein at least one of said plurality of rules is applied to medical related information related to a medical related decision; and

wherein the auditing system audits the medical related decision for compliance with the at least one rule; and

wherein an indication is provided of compliance or non-compliance of the medical related decision with the at least one rule.