Universal Charge Routing System for Medical Billing

• US 20140108038A1
• Filed: 12/17/2013
• Published: 04/17/2014
• Est. Priority Date: 02/27/2004
• Status: Active Grant

• Current Assignee: Epic Systems Corporation
• Original Assignee: Epic Systems Corporation
• Inventors: Lipsky, Mark Robert, Li, Dazhi, Shou, Biao, Baldock, Brandon Jon, Fu, Ting-Sheng, Ma, Tin-Hang Andrew, Keresztes, Alexandre Sena, Harjono, Herman, Shukla, Jagdeesh, Upadhyaya, Nishant
• Granted Patent: US 10,242,158 B2
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/04 Billing or invoicing
• CPC Class Codes: G16H 15/00 ICT specially adapted for medical reports, e.g. generation or transmission thereof
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms

Abstract

A medical charge router receives charge information from a variety of sources and converts it to a standard charge format for automated processing and routing to one of multiple billing programs.)

Claims

1. A charge router for use in medical billing systems having a plurality of charge sources creating charges including charge data and at least one billing program receiving charge data to generate bills, the charge router comprising:

a set of input translators receiving charges from the charge sources and converting the charge data of the charges to universal charges having a common format;

a destination rule engine analyzing the charge data of the universal charges to assign a destination to the universal charges identifying a billing program; and

a set of output translators receiving universal charges and destinations from the destination rule engine and converting the universal charges to a billing program format according to the destination.

2. The charge router of claim 1, wherein the destination rule engine determines the destinations from charge data from which a destination can be inferred.

3. The charge router of claim 1, wherein the charge data is selected from the group consisting of patient information, procedure information, charge code information, department information, time information, place of service, cost information, and provider information.

4. The charge router of claim 1, wherein the common format of the universal charges provides a field for information about a destination billing program and wherein the destination rule engine inserts an identified destination into the universal charge from which it is derived.

5. The charge router of claim 1, further including a work-queue rule engine analyzing the charge data of the universal charges to detect charges that require human review and enrolling the charge data in a work-queue for review by a human operator before forwarding the charge data to an output translator.

6. The charge router of claim 1, further including an error pool and wherein the destination rule engine further identifies universal charges that cannot be processed by the destination rule engine and enrolls the charge data of any erroneous universal charges in an error pool for editing by a human operator without forwarding the charge data of the erroneous universal charges to an output translator.

7. The charge router of claim 1, further including a modification rule engine analyzing the charge data of the universal charges to automatically modify the universal charges before forwarding the charge data of the universal charge to an output translator.

8. The charge router of claim 7, further including a means for forwarding modification made to the universal charges to the charge sources.

9. The charge router of claim 7, wherein each modification rule includes a test section receiving charge data and testing it for a predetermined test condition and a macro section receiving charge data and modifying it according to a macro script dependant on the test condition, wherein the modification rule engine includes an editor for a user to edit test sections and macro sections.

10. The charge router of claim 7, wherein the modification is a creation of a new charge.

11. The charge router of claim 10 wherein the new charge is intended to be received by a different billing program than the charge from which it was created.

12. The charge router of claim 1, further including an administrative data processor collecting data on a flow of charges through the charge router to create a report providing data fields selected from the group consisting of:

charges received, charges successfully transmitted, oldest time stamp of a charge, oldest time stamp of a service provided, an indication of charges in a queue, aging of charges in the queue, and number of charges in an error pool.

13. A medical billing system for a plurality of charge sources creating charge data and at least two billing programs receiving charge data to generate bills, the billing system comprising:

at least one common data link connecting the charge sources to a common data receiving point and the billing programs to a common data providing point;

an electronic computer communicating with the common data receiving point to collect all charge data from the charge sources and communicating with the common data providing point to direct charge data to ones of the billing programs, the electronic computer executing a stored program to;

(i) log at least a portion of the charge data together; and

(ii) in response to a query identifying the portion of the charge data, provide records from the log matching the portion of the charge data together with at least one of a destination and source of the charge data.

14. The medical billing system of claim 13, wherein the query is associated with a charge message and the electronic computer further executes the stored program to:

(i) forward change messages including at least a portion of the charge data to at least one of the destination or source of any identified charge.

15. The medical billing system of claim 13, wherein the query is associated with a charge change message and the electronic computer further executes the stored program to:

(i) forward change messages including at least a portion of the charge data to multiple destinations identified using a portion of the charge data.

16. The medical billing system of claim 13, wherein the billing programs are selected from the group consisting of hospital billing programs and professional billing programs.

17. The medical billing system of claim 13, further including a work-queue rule engine analyzing the charge data to detect charges that require human review and enrolling the charge data in a work-queue for review by a human operator before forwarding the charge data to a billing program.

18. A medical billing system for a plurality of charge sources creating charge data and at least two billing programs receiving charge data to generate bills, the billing system comprising:

at least one common data link connecting the charge sources to a common data receiving point and the billing programs to a common data providing point;

an electronic computer communicating with the common data receiving point to collect all charge data from the charge sources and communicating with the common data providing point to direct charge data to ones of the billing programs, the electronic computer executing a stored program to;

(i) identify selected charges associated with medical procedures normally requiring a bill processed by different billing programs;

(ii) split an identified charge into two charges, each with a different destination; and

(iii) route the two charges to billing programs according to the different destinations.

19. The medical billing system of claim 18, wherein the electronic computer further implements a modification rule engine analyzing the charge data to automatically modify the charge data before forwarding the charge data of the charge to an output translator.

20. The medical billing system of claim 19, wherein the electronic computer further implements a log file storing in a searchable database modification made by the modification rule engine to the charges.