Verifying Charge Codes

• US 20140019160A1
• Filed: 07/16/2012
• Published: 01/16/2014
• Est. Priority Date: 07/16/2012
• Status: Abandoned Application

• Current Assignee: Envision Healthcare Corporation
• Original Assignee: Cmo Rx Inc.
• Inventors: Loya, Francisco III, Williams, Michael
• Application Number:
  US13/550,035
• Publication Number:
  US 20140019160A1
• Time in Patent Office: Days
• US Class Current: 705/3
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 15/00 ICT specially adapted for medical reports, e.g. generation or transmission thereof
• CPC Class Codes: G16H 40/67 for remote operation

Abstract

Systems, methods, and computer program products involve receiving, electronically, medical information about a patient of a medical provider from an electronic medical record. A charge code associated with a medical condition of the patient can be automatically identified from a specified set of a plurality of charge codes upon which a third party will base payment to the medical provider using the received medical information. The charge code can be outputted.

Claims

1. A computer implemented method comprising:

receiving, electronically, medical information about a patient of a medical provider from an electronic medical record;

automatically identifying, using the received medical information, a charge code associated with a medical condition of the patient from a specified set of a plurality of charge codes upon which a third party will base payment to the medical provider; and

outputting the charge code.

2. The computer implemented method of claim 1, wherein receiving the medical information comprises receiving a diagnosis of the medical condition and the examination information, test information, lab information, imaging information, and pharmaceutical information associated with the diagnosis.

3. The computer implemented method of claim 2, wherein the diagnosis and any associated examination information, test information, lab information and pharmaceutical information is from a specified timeframe, and

wherein receiving the medical information further comprises receiving at least one of a historical diagnosis of another medical condition, historical examination information, historical test information, historical lab information, historical imaging information, or historical pharmaceutical information from a timeframe before the specified timeframe.

4. The computer implemented method of claim 2, wherein the charge code is a first charge code corresponding to the medical condition, and the method further comprises automatically identifying a second charge code corresponding to a second medical condition for which no diagnosis is identified in the medical information.

5. The computer implemented method of claim 4, wherein automatically identifying the second charge code comprises automatically identifying the second charge code using the first charge code.

6. The computer implemented method of claim 1, wherein outputting the charge code comprises outputting the charge code to a physician and prompting a confirmation from the physician that the charge code is correct.

7. The computer implemented method of claim 1, further comprising identifying a second charge code associated with the procedure and providing the second charge code to the physician.

8. The computer implemented method of claim 1, further comprising transmitting the charge code to the third party payor.

9. A system comprising:

a hardware processor operable to execute instructions comprising;

receiving medical information about a patient of a medical provider from an electronic medical record;

automatically identifying, using the received medical information, a charge code associated with a medical condition of the patient from a specified set of a plurality of charge codes upon which a third party will base payment to the medical provider; and

outputting the charge code.

10. The system of claim 9, wherein receiving the medical information comprises receiving a diagnosis of the medical condition and the examination information, test information, lab information, imaging information, and pharmaceutical information associated with the diagnosis.

11. The system of claim 10, wherein the diagnosis and any associated examination information, test information, lab information and pharmaceutical information is from a specified timeframe, and

wherein receiving the medical information further comprises receiving at least one of a historical diagnosis of another medical condition, historical examination information, historical test information, historical lab information, historical imaging information, or historical pharmaceutical information from a timeframe before the specified timeframe.

12. The system of claim 10, wherein the charge code is a first charge code corresponding to the medical condition, and the method further comprises automatically identifying a second charge code corresponding to a second medical condition for which no diagnosis is identified in the medical information.

13. The system of claim 12, wherein automatically identifying the second charge code comprises automatically identifying the second charge code using the first charge code.

14. The system of claim 9, wherein outputting the charge code comprises outputting the charge code to a physician and prompting a confirmation from the physician that the charge code is correct.

15. The system of claim 9, the instructions further comprising identifying a second charge code associated with the procedure and providing the second charge code to the physician.

16. The system of claim 9, the instructions further comprising transmitting the charge code to the third party payor.

17. A computer program product tangibly stored on a non-transient computer readable media, the computer program product operable when executed to perform steps comprising:

receive medical information about a patient of a medical provider from an electronic medical record;

automatically identify, using the received medical information, a charge code associated with a medical condition of the patient from a specified set of a plurality of charge codes upon which a third party will base payment to the medical provider; and

output the charge code.

18. The computer program product of claim 17, wherein receiving the medical information comprises receiving a diagnosis of the medical condition and the examination information, test information, lab information, imaging information, and pharmaceutical information associated with the diagnosis.

19. The computer program product of claim 18, wherein the diagnosis and any associated examination information, test information, lab information and pharmaceutical information is from a specified timeframe, and

wherein receiving the medical information further comprises receiving at least one of a historical diagnosis of another medical condition, historical examination information, historical test information, historical lab information, historical imaging information, or historical pharmaceutical information from a timeframe before the specified timeframe.

20. The computer program product of claim 18, wherein the charge code is a first charge code corresponding to the medical condition, and the method further comprises automatically identifying a second charge code corresponding to a second medical condition for which no diagnosis is identified in the medical information.

21. The computer program product of claim 20, wherein automatically identifying the second charge code comprises automatically identifying the second charge code using the first charge code.

22. The computer program product of claim 17, wherein outputting the charge code comprises outputting the charge code to a physician and prompting a confirmation from the physician that the charge code is correct.

23. The computer program product of claim 17, further operable when executed to identify a second charge code associated with the procedure and providing the second charge code to the physician.

24. The computer program product of claim 17, further operable when executed to transmit the charge code to the third party payor.