Medical billing system and method

• US 20020198741A1
• Filed: 03/18/2002
• Published: 12/26/2002
• Est. Priority Date: 06/22/2001
• Status: Abandoned Application

• Current Assignee: Philip Randazzo
• Original Assignee: Philip Randazzo
• Inventors: Randazzo, Philip
• Application Number:
  US10/100,358
• Publication Number:
  US 20020198741A1
• Time in Patent Office: Days
• US Class Current: 705/3
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/06 Buying, selling or leasing transactions
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records

Abstract

A method and system for processing medical claims resulting from the treatment of a patient by a healthcare provider, including processing the claim by a third party database to identify errors in the claim prior to submission to an indemnitor, is disclosed.

Claims

1. A method for processing a claim for treatment of a patient by a healthcare provider for submission to an indemnitor, the method comprising:

creating an electronic claim containing patient information, the claim being for an amount of money;

processing the claim by a third party facilitator via a database of verification codes to identify errors in the patient information prior to initial submission of the claim to the indemnitor;

providing an advance payment by the third party facilitator to the healthcare provider;

submitting the claim to the indemnitor for payment of the amount of money; and

,

receiving the payment of the amount of money by the third party from the indemnitor.

2. The method of claim 1 wherein the step of creating an electronic claim includes opening an electronic file by the healthcare provider.

3. The method of claim 1 wherein creating the claim includes on-line editing using a series of verification codes.

4. The method of claim 3 wherein the verification codes include patient demographic information.

5. The method of claim 3 wherein the verification codes include healthcare provider fees.

6. The method of claim 3 wherein the verification codes include classified procedures and treatment codes.

7. The method of claim 3 wherein the verification codes are centrally located on software through an application service provider.

8. The method of claim 7 wherein the software containing the verification codes can be accessed and updated by the third party facilitator.

9. The method of claim 1 wherein processing the claim includes cross-checking information in the claim with the verification codes.

10. The method of claim 1 wherein processing the claim can be performed by the application service provider.

11. The method of claim 1 wherein processing the claim further includes returning a claim containing erroneous patient information to the healthcare provider for correction.

12. The method of claim 1 wherein providing an advance payment to the healthcare provider includes electronic transfer of funds at a set interval.

13. The method of claim 11 wherein the advance payment is less than the amount of money in the claim.

14. The method of claim 12 wherein the advance payment is a fixed percentage of the amount of money in the claim.

15. The method of claim 12 wherein the advance payment is a fixed percentage of the amount of money in the claim less further a percentage for a reserve fund.

16. The method of claim 1 wherein processing the claim further includes facilitating a subsequent verification of the claim through an electronic clearinghouse.

17. The method of claim 15 wherein the clearinghouse notifies the third party facilitator of errors in the claim.

18. The method of claim 16 wherein the electronic clearinghouse further edits the claim, including formatting the claim according to individual indemnitor standards.

19. The method of claim 16 wherein the formatted claim is submitted to the indemnitor.

20. The method of claim 16 wherein the formatted claim is further evaluated for correctness by the indemnitor.

21. The method of claim 16 wherein the formatted claim paid by the indemnitor.

22. The method of claim 1 wherein the process further includes billing the patient for outstanding amounts due.

23. The method of claim 1 wherein receiving the payment from the indemnitor further includes following-up with the indemnitor on unadjudicated claims.

25. The billing system of claim 23 wherein the means for processing the claim includes on-line editing of the claims using a series of verification codes.

26. The billing system of claim 24 wherein the means for processing the claim includes immediate electronic notification of errors in the claim.

27. The billing system of claim 24 wherein the means for processing the claim further includes correction of the errors by the healthcare provider and re-submission of the claim for verification.

28. The billing system of claim 24 wherein the means for processing the claim includes second verification of the claim at an electronic clearinghouse for further identification of errors.

29. The billing system of claim 24 wherein the means for advancing payment to the healthcare provider includes electronic transfer of funds at regular intervals.

30. The billing system of claim 24 wherein the means for advancing funds includes submission of a complete, correct and clean claim to the indemnitor.

24. A billing system for submitting medical claims created by a healthcare provider for pre-payment approval comprising:

an electronic medical claim containing patient information;

a means for processing the claim by a third party via a database of verification codes and to identify errors in the claim prior to initial submission of the claim for payment by an indemnitor; and

,

a means for advancing payment of the claim to the healthcare provider prior to payment by the indemnitor.

31. A method for processing a claim for treatment of a patient by a healthcare provider for submission to an indemnitor, the method comprising:

providing a software having a matrix for creating a claim for an amount of money;

creating an electronic claim containing patient information, using the software;

processing the claim through a first tier filtering process using a third party application service provider having a software database containing verification codes to identify errors in the patient information prior to submission of the claim to the indemnitor;

processing the claim through a second tier filtering process using a clearinghouse for further verification and identification of errors in the claim;

providing an advance payment by the third party to the healthcare provider;

submitting the claim through a third tier filtering process to the indemnitor for approval and subsequent payment of the amount of money; and

,

receiving the payment of the amount of money by the third party from the indemnitor; and

,

following up by the third party with indemnitor concerning any nonpayment on the claim.