Medical billing auditing method and system
First Claim
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1. A method for assessing billing compliance of a medical related decision prior to the medical related decision being finalized, the method comprising:
- receiving the medical related decision inputted by a medical professional using a user interface;
applying at least one rule to the medical related decision, the at least one rule being stored on a memory and accessible using the user interface;
auditing the medical related decision for compliance with the at least one rule;
providing results of the audit prior to the medical related decision that is inputted by the medical professional is finalized so that the medical professional can finalize the medical related decision based on billing compliance;
wherein the results include an indication of billing compliance or billing non-compliance of the medical related decision with the rules;
wherein an indication of billing non-compliance of the medical related decision that is inputted by the medical professional is presented to the medical professional prior to the medical related decision that is inputted by the medical professional is finalized so that the medical professional is prevented from making the medical related decision if the indication of billing non-compliance is provided to the medical professional;
wherein an indication of billing compliance of the medical related decision that is inputted by the medical professional allows the medical related decision that is inputted by the medical professional to be finalized; and
wherein the steps of receiving medical related information, applying the at least one rule, auditing the medical related decision and providing results of the audit are carried out on a computer.
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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.
31 Citations
23 Claims
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1. A method for assessing billing compliance of a medical related decision prior to the medical related decision being finalized, the method comprising:
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receiving the medical related decision inputted by a medical professional using a user interface; applying at least one rule to the medical related decision, the at least one rule being stored on a memory and accessible using the user interface; auditing the medical related decision for compliance with the at least one rule; providing results of the audit prior to the medical related decision that is inputted by the medical professional is finalized so that the medical professional can finalize the medical related decision based on billing compliance; wherein the results include an indication of billing compliance or billing non-compliance of the medical related decision with the rules; wherein an indication of billing non-compliance of the medical related decision that is inputted by the medical professional is presented to the medical professional prior to the medical related decision that is inputted by the medical professional is finalized so that the medical professional is prevented from making the medical related decision if the indication of billing non-compliance is provided to the medical professional; wherein an indication of billing compliance of the medical related decision that is inputted by the medical professional allows the medical related decision that is inputted by the medical professional to be finalized; and wherein the steps of receiving medical related information, applying the at least one rule, auditing the medical related decision and providing results of the audit are carried out on a computer. - View Dependent Claims (2, 3, 4, 5, 6)
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7. A method for assessing billing compliance of a medical related decision prior to the medial related decision being finalized, the method comprising:
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receiving the medical related decision inputted by a medical professional using a user interface; receiving a billing related decision inputted by the medical professional using the user interface; applying at least one rule to the medical related decision and the billing related decision, the at least one rule being stored on a memory and accessible using the user interface; auditing the medical related decision and the billing related decision for compliance with the at least one rule; providing results of the audit prior to the medical related decision and the billing related decision is finalized; wherein the results include an indication of compliance or non-compliance of the medical related decision and the billing related decision with the at least one rule; wherein an indication of compliance non-compliance of the medical related decision is presented to the medical professional prior to the medical related decision being finalized so that the medical professional is prevented from making the medical related decision if the indication of non-compliance is provided to the medical professional; wherein compliance with the at least one rule is verified prior to the medical related decision being finalized; wherein payment from an insurance company is automatically made to the medical professional upon verification of compliance of both the medical related decision and the billing related decision with the at least one rule; wherein the steps of receiving the medical related decision, making the billing related decision, applying the at least one rule and auditing the medical related decision and the billing related decision are carried out using a computer. - View Dependent Claims (8, 9, 10, 11)
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12. A billing compliance assessment system comprising:
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at least one user interface; a plurality of rules stored on a memory and accessible using the at least one user interface; and an auditing system in communication with the plurality of rules; wherein at least one of the plurality of rules is applied to a medical related decision and a billing related decision made by a medical professional; wherein the auditing system audits the medical related decision and the billing related decision made by the medical professional for compliance with the at least one rule prior to the medical related decision being finalized; wherein results of the audit are provided prior to the medical related decision being finalized so that the medical related decision can be finalized based on compliance of the medical related decision and the billing related decision with the at least one rule; wherein an indication is provided to the medical professional of compliance or non-compliance of both the medical related decision and the billing related decision with the at least one rule prior to the medical related decision being finalized so that the medical professional is prevented from making the medical related decision if the indication of non-compliance is provided to the medical professional; wherein an insurance company is notified of patient treatment; and wherein the auditing system automatically audits the medical related decision so that an insurance standard is verifiable and so that a payment from the insurance company is automatically made upon verification of compliance of the medical related decision with the at least one rule. - View Dependent Claims (13, 14, 15, 16, 17)
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18. A method for assessing billing compliance of a medical related decision relating to a medical professional recommending a medical procedure prior to the medical related decision relating to recommending the medical procedure is finalized, the method comprising:
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receiving information inputted by a medical professional relating to the recommendation for the medical procedure using a user interface; applying at least one rule to the recommendation for the medical procedure, the at least one rule being stored on a memory and accessible using the user interface; auditing the recommendation for the medical procedure for compliance with the at least one rule; providing results of the audit prior to the recommendation for the medical procedure is finalized so that the medical professional can finalize the recommendation based on billing compliance; wherein an indication of non-compliance of the information relating to the recommendation for the medical procedure that is inputted by the medical professional is presented to the medical professional prior to the recommendation being finalized so that the medical professional is prevented from making the recommendation if the indication of non-compliance is provided to the medical professional; wherein an indication of compliance of the information relating to the recommendation for the medical procedure that is inputted by the medical professional allows the medical professional to finalize the recommendation for the medical procedure; and wherein the steps of receiving medical related information, applying the at least one rule, auditing the recommendation for the medical procedure and providing results of the audit are carried out on a computer. - View Dependent Claims (19, 20, 21, 22, 23)
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Specification