Integrated medical software system with location-driven bill coding

• US 8,781,853 B2
• Filed: 04/08/2011
• Issued: 07/15/2014
• Est. Priority Date: 04/19/2002
• Status: Expired due to Term

• Current Assignee: Greenway Health Incorporated (VCG Holdings LLC)
• Original Assignee: Greenway Medical Technologies Incorporated
• Inventors: Green, W. Thomas III, Ingram, James T., Samples, Johnathan, Schulenburg, Gregory H.
• Primary Examiner(s): NGUYEN, TRAN N
• Application Number:
  US13/083,420
• Publication Number:
  US 20110258001A1
• Time in Patent Office: 1,194 Days
• Field of Search: 705/2
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• 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 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms

Abstract

An integrated medical software system with location-driven bill coding is disclosed. The system comprises an information component that automatically retrieves payment method data and demographic data for a patient and location data for a healthcare provider; a clinical component that captures at least one of a diagnosis code, a procedure code, and an evaluation and management (E&M) code as at least one of a clinician and a staff member at the healthcare provider inputs clinical data for the patient into the an electronic document during an encounter with the patient; a mapping component that automatically associates a billing code with the at least one of a pathology code, a procedural code, and an E&M code and assigns a service cost to the billing code based on a pre-defined fee schedule, said pre-defined fee schedule being automatically chosen based on the location data for the healthcare provider; and a service detail entry component that uses the payment method data and the demographic data for the patient and the service cost to automatically generate at least one of a bill, a claim, and a statement for the patient.

Claims

1. An integrated medical software system with location-driven bill coding, the system comprising:

a processor configured to execute;

an information software component to automatically retrieve payment method data and demographic data for a patient and geographic region location data for a healthcare provider;

a clinical software component to capture at least one of a diagnosis code, a procedure code, and an evaluation and management (E&

M) code as at least one of a clinician and a staff member at the healthcare provider inputs clinical data for the patient into an electronic document during an encounter with the patient;

a mapping software component to automatically associate a billing code with the at least one of a diagnosis code, a procedure code, and an E&

M code and assigns a service cost to the billing code based on a pre-defined fee schedule, wherein said mapping software component obtains the geographic region location data for the healthcare provider, automatically chooses the pre-defined fee schedule in accordance with the geographic region location data, and automatically assigns the service cost to the billing code in accordance with the pre-defined fee schedule; and

a service detail entry software component to use the payment method data and the demographic data for the patient and the service cost to automatically generate at least one of a bill, a claim, and a statement for the patient.

2. The integrated software system of claim 1, wherein the processor is further configured to execute an administrative software component to provide:

a plurality of pre-defined fee schedules from which the mapping software component chooses said pre-defined fee schedule based on the geographic region location data of the healthcare provider; and

allowed amount data corresponding to a payer identified by the payment method data for the patient,

wherein the allowed amount data and the chosen pre-defined fee schedule is used by the service detail entry component to determine an allowed service cost that the payer will pay for the patient.

3. The integrated software system of claim 2, wherein the processor is configured such that the service detail entry software component automatically recalculates the allowed service cost when at least one of the payer identified by the payment method data of the patient changes and the allowed amount data corresponding to the payer changes.

4. The integrated software system of claim 1, wherein the processor is further configured to execute:

a database that stores scheduling data, financial data, the demographic data, and the clinical data for the patient in a normalized data format;

a scheduling software module to capture scheduling data in the normalized data format and to schedule the patient and at least one of a clinician, a staff member, and equipment at a healthcare provider using the scheduling data and the demographic data, said scheduling data including the geographic region location data for the healthcare provider;

an account management software module to capture financial data for the patient in the normalized data format, said account management software module including the information software component, the mapping software component, and the service detail entry software component, and said financial data including the payment method data for the patient and the service cost;

a clinical software module to create the electronic document and to capture the clinical data in the normalized data format, said clinical module including the clinical component; and

a framework software module that is integrated with the scheduling software module, the account management software module, and the clinical module using a common architecture and that supports an exchange of the scheduling data, the financial data, the demographic data, and the clinical data between those software modules and with the database in the normalized data format.

5. The integrated software system of claim 4, wherein the processor is further configured to execute:

a registration software module to capture the demographic data for the patient, said demographic data including at least one of a name, a digital photograph, an address, a date of birth, an age, a social security number, and a sex of the patient,

wherein the information software component automatically retrieves the demographic data for the patient from the registration software module.

6. The integrated software system of claim 4, wherein the processor is further configured such that the information software component automatically retrieves the geographic region location data for the healthcare provider from the scheduling software module.

7. The integrated software system of claim 1, wherein the processor is further configured to execute an administrative software component to provide functionality for viewing at least one of a bill, a claim, and a statement for the patient generated at multiple healthcare providers based on a common tax identifier shared by those healthcare providers.

8. The integrated software system of claim 1, wherein the processor is further configured such that:

the information software component also automatically retrieves date of service data and healthcare provider identification data for the patient and the healthcare provider; and

the service detail entry software component also uses the date of service information and the healthcare provider identification information to automatically generate the at least one of a bill, a claim, and a statement.

9. The integrated software system of claim 1, wherein the processor is further configured such that the service detail entry software component uses the payment method data and the demographic data for the patient and the service cost to automatically generate an electronic insurance claim and communicates with an automated claims clearinghouse to electronically process the insurance claim.

10. The integrated software system of claim 9, wherein the processor is further configured such that:

the insurance claim is generated by automatically populating each required field in an institutional or professional claim form; and

the institutional or professional claim form is communicated to the automated claim clearinghouse in the ANSI X12 837 data format.

11. A method for providing location-driven bill coding with an integrated medical software system, said integrated medical software system having a processor that executes the method, said method comprising:

(a) executing an information software component using the processor to automatically retrieve payment method data and demographic data for a patient and geographic region location data for a healthcare provider;

(b) executing a clinical software component using the processor to capture at least one of a diagnosis code, a procedure code, and an evaluation and management (E&

M) code as at least one of a clinician and a staff member at the healthcare provider inputs clinical data for the patient into the an electronic document during an encounter with the patient;

(c) executing a mapping software component using the processor to automatically associate a billing code with the at least one of a pathology code, a procedural code, and an E&

M code and to assign a service cost to the billing code based on a pre-defined fee schedule, wherein said mapping software component obtains the geographic region location data for the healthcare provider, automatically chooses the pre-defined fee schedule in accordance with the geographic region location data, and automatically assigns the service cost to the billing code in accordance with the pre-defined fee schedule; and

(d) executing a service detail entry software component in the processor to automatically generate at least one of a bill, a claim, and a statement for the patient with the payment method data and the demographic data for the patient and the service cost.

12. The method of claim 11, further comprising the steps of executing an administrative software component using the processor that includes

a plurality of pre-defined fee schedules from which the mapping software component chooses said pre-defined fee schedule based on the geographic region location data of the healthcare provider, and

allowed amount data corresponding to a payer identified by the payment method data for the patient;

and

using the service detail entry software component to determine an allowed service cost that the payer will pay for the patient based on the chosen pre-defined fee schedule and the allowed amount data.

13. The method of claim 12, further comprising the step of executing said service detail entry software component using the processor for automatically recalculating the allowed service cost when at least one of the payer identified by the payment method data of the patient and the allowed amount data corresponding to the payer changes.

14. The method of claim 11, further comprising the steps of:

(e) executing a scheduling software module using the processor to capture scheduling data in a normalized data format and to schedule the patient and at least one of a clinician, a staff member, and equipment at a healthcare provider using the scheduling data and the demographic data, said scheduling data including the geographic region location data for the healthcare provider;

(f) executing an account management software module using the processor to capture financial data for the patient in the normalized data format, said account management software module including the information software component, the mapping software component, and the service detail entry software component, and said financial data including the payment method data for the patient and the service cost;

(g) executing a clinical software module using the processor to create the electronic document, said clinical module including the clinical component; and

(h) executing a database using the processor to store the scheduling data, the financial data, the demographic data, and the clinical data for the patient in the normalized data format,

wherein a framework software module is integrated with the scheduling software module, the account management software module, and the clinical software module using a common architecture and that supports an exchange of the scheduling data, the financial data, the demographic data, and the clinical data between those software modules and with the database in the normalized data format.

15. The method of claim 14, further comprising the step of:

(i) executing a registration software module using the processor to capture the demographic data for the patient, said demographic data including at least one of a name, a digital photograph, an address, a date of birth, an age, a social security number, and a sex of the patient,

wherein the information software component automatically retrieves the demographic data for the patient from the registration software module.

16. The method of claim 14, wherein the information software component automatically retrieves the geographic region location data for the healthcare provider from the scheduling software module.

17. The method of claim 11, wherein the service detail entry software component

uses the payment method data and the demographic data for the patient and the service cost to automatically generate an electronic insurance claim, and

communicates with an automated claims clearinghouse to electronically process the insurance claim.

18. The method of claim 17, wherein

the insurance claim is generated by automatically populating each required field in an institutional or professional claim form;

and

the institutional or professional claim form is communicated to the automated claim clearinghouse in the ANSI X12 837 data format.

19. The method of claim 11, further comprising the step of executing an administrative software component using the processor to view at least one of a bill, a claim, and a statement for the patient generated at multiple healthcare providers based on a common tax identifier shared by those healthcare providers.

20. The method of claim 11, wherein

the information software component also automatically retrieves date of service data and healthcare provider identification data for the patient and the healthcare provider;

and

the service detail entry software component also uses the date of service information and the healthcare provider identification information to automatically generate the at least one of a bill, a claim, and a statement.