Medical document attachment handling

• US 20080103836A1
• Filed: 10/31/2006
• Published: 05/01/2008
• Est. Priority Date: 10/31/2006
• Status: Abandoned Application

• Current Assignee: Athenahealth Incorporated
• Original Assignee: Athenahealth Incorporated
• Inventors: Park, Edward, Amar, Anshul
• Application Number:
  US11/590,255
• Publication Number:
  US 20080103836A1
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 20/14 specially adapted for billing systems
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records

Abstract

Automating medical practice workflow and billing presents difficulties in many aspects, especially in interacting with the workflow, other healthcare providers, and within the constraints of payor requirements. Disclosed are methods, systems, software and means for automatically providing additional documentation to reconcile a billing claim. In one implementation, there is a computerized method for automatically providing additional documentation to reconcile a billing claim. The method, typically executed in software, includes providing a billing claim based on a patient'"'"'s workflow, the billing claim typically associated with an a payor such as an insurance provider. The method also involves automatically identifying a document associated with the billing claim based on the patient'"'"'s workflow. Typically the claim is submitted to the payor and the document is sent to the payor as well, the communications with the payor occurring over a communications network.

Claims

1. A computerized method for automatically providing additional documentation to reconcile a billing claim comprising:

providing a billing claim based on a first patient workflow;

automatically identifying a document associated with the billing claim based on the first patient workflow;

submitting the claim to a payor over a first communications network; and

sending the document to the payor over the first communications network.

2. The method of claim 1 further comprising receiving a billing message from the payor associated with the first patient workflow.

3. The method of claim 2 wherein the identifying step is performed in response to receiving the billing message.

4. The method of claim 1 wherein the identifying step is performed in anticipation of receiving a billing message from the payor.

5. The method of claim 1 wherein the document is identified based on a prior billing message received from the payor.

6. The method of claim 5 wherein the prior billing message received from the payor is associated with a second patient workflow.

7. The method of claim 1 wherein the payor associated with the billing claim is an insurance provider.

8. The method of claim 1 wherein identifying the document comprises creating the document from data elements associated with the first patient workflow.

9. The method of claim 1 further comprising receiving an image over a second communications network.

10. The method of claim 9 wherein identifying the document comprises determining the image is the document.

11. The method of claim 10 wherein the image is received via facsimile.

12. The method of claim 10 wherein the image is received via an electronic message.

13. The method of claim 12 wherein the electronic message is an electronic claim.

14. The method of claim 10 wherein the image is a scanned document.

15. The method of claim 1 further comprising determining that the document is not available and automatically waiting to submit the claim to the payor until the document is provided.

16. A system for automatically providing additional documentation to reconcile a billing claim comprising:

a workflow processing engine performing one or more automated patient workflow tasks associated with information associated with an event related to a patient,

a rules engine in communication with the workflow processing engine for repeatedly and automatically interacting with the information associated with the event by applying one or more rules in a set of rules to the information in connection with the performance of the one or more of the automated patient workflow tasks;

an intelligent transactions relationship module in communication with the workflow processing engine and a payor server for repeatedly and automatically interacting with the information associated with the event by performing transactions with the payor server in connection with the performance of one or more automated patient workflow tasks; and

an attachment processing module in communication with the workflow processing engine and the intelligent transactions relationship module for identifying a document associated with the information associated with the event and for interacting with the intelligent transactions relationship module to send the document to the payor server.

17. The system of claim 16 wherein the attachment processing module is configured to receive a billing message from the payor server associated with the event.

18. The system of claim 17 wherein the attachment processing module is further configured to identify the document in response to receiving the billing message from the payor server.

19. The system of claim 16 wherein the attachment processing module is configured to identify the document in anticipation of receiving a billing message from the payor server.

20. The system of claim 16 wherein the attachment processing module is configured to identify the document based on a prior billing message received from the payor server.

21. A computerized means for automatically providing additional documentation to reconcile a billing claim comprising:

means for providing a billing claim based on a patient workflow;

means for automatically identifying a document associated with the billing claim based on the patient workflow;

means for submitting the claim to a payor over a communications network; and

means for sending the document to the payor over the communications network.

22. A computer program product, tangibly embodied in an information carrier, for automatically providing additional documentation to reconcile a billing claim, the computer program product including instructions being operable to cause data processing apparatus to:

provide a billing claim based on a patient workflow;

identify a document associated with the billing claim based on the patient workflow;

submit the claim to a payor; and

send the document to the payor.