System and Method to Analyze a Billing System Database and Revenue Performance by Applying Scientifically Proven Statistical Filters to Analyze Variation and Identify Useful Exceptions

• US 20100174627A1
• Filed: 07/02/2009
• Published: 07/08/2010
• Est. Priority Date: 08/25/2008
• Status: Abandoned Application

• Current Assignee: Audit Quality Incorporated
• Original Assignee: Audit Quality Incorporated
• Inventors: Daniels, Mark S.
• Application Number:
  US12/497,453
• Publication Number:
  US 20100174627A1
• Time in Patent Office: Days
• US Class Current: 705/30
• CPC Class Codes: G06Q 10/06 Resources, workflows, human or project management; Enterprise or organisation planning; Enterprise or organisation modelling
• CPC Class Codes: G06Q 40/12 Accounting

Abstract

Described herein are systems and methods for obtaining information and evaluating billing system process data to predict where problems occur. The systems and methods may be used to evaluate data collected over time by individual clients and their billing service providers. The systems and methods provide the ability to monitor any billing process and predict where problems and opportunities are in precise ways utilizing statistical rules and theories as well as control charts to analyze the existing billing data for clients to produce charts that reveal desired information, alerting the user to any exceptions, variations or abnormalities in the data as an exception report. Exceptions identified are presented in a summary file or other format allowing the user to quickly expose significant variation and assess the need for corrective action.

Claims

1. A computer program, stored in a tangible storage medium, for analyzing billing data, the program comprising executable instructions that cause a computer to:

receive dataset target requirements from a user;

receive a dataset comprising billing data from a user;

format the dataset in accordance with the dataset target requirements to produce a formatted dataset;

identify statistical exceptions from the formatted dataset; and

report the statistical exceptions to the user.

2. The computer program of claim 1, wherein the dataset requirements are selected from the group consisting of purging old data, combining new data with old data, and adding new data fields, and combinations thereof.

3. The computer program of claim 1, wherein the dataset comprising billing data is selected from the group consisting of modality, provider and practice identification numbers, site/service location name, point of service, insurance type, patient type, attending doctor name, referring doctor name, date of service, procedural codes (CPT), quantity (CPT count), charge amount, payment amount, adjustment amount, write-off amount and description, charge entry date, payment entry date, adjustment entry date, write-off entry date, time, counts, errors, first-pass pay rate, denial rate, percent of accounts receivable beyond 60, 90 and 120 days, net collection ratio, gross collection ratio, average charges and payments, and relative value units (RVU), and combinations thereof.

4. The computer program of claim 1, wherein the executable instructions further cause a computer to:

examine the received dataset to ensure that the received dataset meets the received dataset target requirements.

5. The computer program of claim 1, wherein the received dataset is in the form of a text file, a flat file extract, or a tab delimited file.

6. The computer program of claim 1, wherein the executable instructions further cause a computer to:

store the formatted dataset.

7. The computer program of claim 1, wherein the statistical exceptions are identified utilizing tools from the group consisting of a 3-standard deviation limit, a 2-standard limit, variation between consecutive points, trends, run lengths and combinations thereof.

8. The computer program of claim 1, wherein the statistical exceptions are reported to the user in a diagram selected from the group consisting of a bar chart, control chart, run chart, table, graph, and combinations thereof.

9. The computer program of claim 1, wherein the executable instructions further cause a computer to:

report the data in the formatted dataset to the user.

10. The computer program of claim 1, wherein the statistical exceptions are reported to the user on a secured, regular basis or on demand through requests.

11. A computer-implemented method of analyzing billing data, the method comprising:

receiving dataset target requirements from a user;

receiving a dataset comprising billing data from a user;

formatting the dataset in accordance with the dataset target requirements to produce a formatted dataset;

identifying statistical exceptions from the formatted dataset; and

reporting the statistical exceptions to the user,

wherein the formatting the dataset is performed by at least one module residing in a processor.

12. The method of claim 11, wherein the dataset requirements are selected from the group consisting of purging old data, combining new data with old data, and adding new data fields, and combinations thereof.

13. The method of claim 11, wherein the dataset comprising billing data is selected from the group consisting of modality, provider and practice identification numbers, site/service location name, point of service, insurance type, patient type, attending doctor name, referring doctor name, date of service, procedural codes (CPT), quantity (CPT count), charge amount, payment amount, adjustment amount, write-off amount and description, charge entry date, payment entry date, adjustment entry date, write-off entry date, time, counts, errors, first-pass pay rate, denial rate, percent of accounts receivable beyond 60, 90 and 120 days, net collection ratio, gross collection ratio, average charges and payments, and relative value units (RVU), and combinations thereof.

14. The method of claim 11, further comprising:

examining the received dataset to ensure that the received dataset meets the received dataset target requirements.

15. The method of claim 11, wherein the received dataset is in the form of a text file, a flat file extract, or a tab delimited file.

16. The method of claim 11, further comprising:

storing the formatted dataset.

17. The method of claim 11, wherein the statistical exceptions are identified utilizing tools from the group consisting of a 3-standard deviation limit, a 2-standard limit, variation between consecutive points, trends, run lengths and combinations thereof.

18. The method of claim 11, wherein the statistical exceptions are reported to the user in a diagram selected from the group consisting of a bar chart, control chart, run chart, table, graph, and combinations thereof.

19. The method of claim 11, further comprising:

reporting the data in the formatted dataset to the user.

20. The method of claim 11, wherein the statistical exceptions are reported to the user on a secured, regular basis or on demand through requests.