System and method for accounting and billing patients in a hospital environment

• US 7,467,094 B2
• Filed: 04/29/2005
• Issued: 12/16/2008
• Est. Priority Date: 06/23/1999
• Status: Expired due to Term

• Current Assignee: Visicu Incorporated (Koninklijke Philips N.V.)
• Original Assignee: Visicu Incorporated (Koninklijke Philips N.V.)
• Inventors: Breslow, Michael, Rosenfeld, Brian A.
• Primary Examiner(s): Morgan; Robert
• Assistant Examiner(s): COUPE, ANITA YVONNE
• Application Number:
  US11/118,950
• Publication Number:
  US 20050203777A1
• Time in Patent Office: 1,327 Days
• Field of Search: 340/500, 340/506, 340/573.1, 340/3.1, 340/3.7, 340/539.12, 34053916-53918, 340/7.29, 705/2, 705/3, 600300-302, 709/217
• US Class Current: 705/3
• CPC Class Codes: G06Q 30/04 Billing or invoicing
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients
• CPC Class Codes: G16H 20/40 relating to mechanical, radiation or invasive therapies, e.g. surgery, laser therapy, dialysis or acupuncture
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

A system and method for accounting and billing patients in a hospital environment. A hospitalized patient is associated with a patient identifier. Billable services provided to the hospitalized patient are associated with the patient identifier. If the billable service is provided by a physician, a physician identifier is also associated with the billable service. The hospitalized patient is scored and a current procedural terminology (CPT) assignment manager assigns CPT codes to the billable service. A bill generator receives the patient data, patient insurance information, physician insurance information, and CPT codes and generates a bill for the billable services provided to the hospitalized patient.

Claims

1. An accounting and billing system for patients in a hospital environment comprising:

a telecommunication network;

monitoring stations comprising monitoring equipment, wherein the monitoring equipment comprises instructions for monitoring data elements from geographically dispersed hospitalized patients and sending the monitored data elements to a remote command center via the telecommunications network,

wherein the remote command center comprises instructions for;

receiving the monitored data elements from the geographically dispersed hospitalized patients;

accessing patient data elements indicative of a medical condition associated with each of the geographically dispersed hospitalized patients;

establishing patient-specific rules associated with each of the geographically dispersed hospitalized patients; and

applying the patient-specific rules continuously and simultaneously using a rules engine, wherein the rules engine comprises instructions for;

selecting data elements from the monitored data elements and the patient data elements associated with a hospitalized patient;

applying a patient-specific rule associated with the hospitalized patient to the selected data elements;

determining in an automated fashion at the remote command center 24 hours per day 7 days per week whether the patient-specific rule for the hospitalized patient has been contravened; and

in the event the patient-specific rule for the hospitalized patient has been contravened, determining in an automated fashion whether intervention is warranted;

a decision support module comprising instructions for, in the event the patient-specific rule for the hospitalized patient has been contravened;

accessing a decision support algorithm;

applying the decision support algorithm to the selected patient data elements of the hospitalized patient; and

providing patient care guidance formulated to return the medical condition of the patient to compliance with the patient specific rule, whereby the treatment of hospitalized patients is standardized; and

a bill generator, wherein the bill generator comprises instructions for;

receiving a patient ID associated with the hospitalized patient;

receiving a current procedural terminology (CPT) code from a CPT code assignment manager for a billable service provided to the hospitalized patient associated with the patient ID, wherein the billable service is selected from a monitoring service and a patient care service; and

assembling a bill for the billable service provided to the hospitalized patient associated with the patient ID using the CPT codes.

2. The system of claim 1, wherein the patient ID is associated with a treatment location.

3. The system of claim 1, wherein the patient data are selected from the group consisting of patient identifying information, patient demographic information, patient admission data, patient laboratory results data, patient insurance data, patient guarantor information, a diagnosis code, attending physician data, and patient representative contact information.

4. The system of claim 1, wherein the patient data further comprise a patient insurance carrier ID, a patient insurance plan name, a patient insurance policy number, and a patient insurance group number.

5. The system of claim 1, wherein the billable service is provided by a physician and wherein:

the bill generator further comprises instructions for;

associating a physician ID with a physician;

receiving physician insurance information and associating the physician insurance information with the physician ID;

associating the provision of the billable service with the physician ID;

receiving the physician ID; and

assembling the bill for the billable service for the hospitalized patient associated with the patient ID using the physician ID.

6. The system of claim 5, wherein the physician ID is associated with physician identifying information, and wherein the physician identifying information comprises the physician'"'"'s name, the physician'"'"'s credentials, and the physician'"'"'s role in treating the hospitalized patient.

7. The system of claim 5, wherein the physician insurance information comprises a physician insurance provider number and a physician insurance provider ID.

8. The system of claim 1, wherein the patient care service is selected from the group consisting of a doctor consultation, a follow-up visit, a time-related visit, a medical procedure, a diagnostic procedure, a laboratory procedure, administration of medication, and a surgical procedure.

9. The system of claim 1, wherein the patient care service is provided from a location that is remote from the location of the hospitalized patient.

10. The system of claim 1, wherein the bill generator further comprises instructions for verifying the billing data.

11. The system of claim 1, wherein the bill generator further comprises instructions for generating a patient stay summary.

12. The system of claim 1, wherein the bill generator further comprises instructions for submitting a claim form to an insurance carrier associated with the hospitalized patient.

26. The system of claim 1, wherein the bill generator further comprises instructions for associating the billable service with the patient ID and a date of service.

27. The system of claim 1, wherein the telecommunications network is selected from the group consisting of a wired network, a wireless network, a cable network, a fiber optic network, and the Internet.

29. The system of claim 1, wherein the remote command center further comprises:

an external network interface, wherein the external network interface comprises instructions for connecting to an external network; and

instructions for providing a health care provider access to the remote command center via the external network.

30. The system of claim 29, wherein the external network is selected from the group consisting of a wired network, a wireless network, a cable network, a fiber optic network, and the Internet.

31. The system of claim 29, wherein the health care provider is selected from the group consisting of a physician, a nurse, a clinician, a diagnostician, and a intensivist.

32. The system of claim 29, wherein the remote command center further comprises instructions for sending the health care provider an alert if the patient-specific rule for the hospitalized patient has been contravened.

13. A method for accounting and billing patients in a hospital environment comprising:

receiving at a remote command center monitored data elements from geographically dispersed hospitalized patients via a telecommunications network;

accessing patient data elements indicative of a medical condition associated with each of the geographically dispersed hospitalized patients;

establishing patient-specific rules associated with each of the geographically dispersed hospitalized patients;

selecting data elements from the monitored data elements and the patient data elements associated with a hospitalized patient;

applying a patient-specific rule associated with the hospitalized patient to the selected data elements;

making a determination in an automated fashion at the remote command center 24 hours per day 7 days per week whether the patient-specific rule for the hospitalized patient has been contravened; and

in the event the patient-specific rule for the hospitalized patient has been contravened;

determining in an automated fashion whether intervention is warranted; and

accessing a decision support algorithm;

applying the decision support algorithm to the selected patient data elements of the hospitalized patient;

providing patient care guidance formulated to return the medical condition of the patient to compliance with the patient specific rule, whereby the treatment of hospitalized patients is standardized;

receiving a patient ID associated with the hospitalized patient;

receiving a current procedural terminology (CPT) code from a CPT assignment manager for a billable service, wherein the billable service is selected from a monitoring service and a patient care service; and

assembling a bill for the billable service provided to the hospitalized patient associated with the patient ID using the CPT codes.

14. The method for accounting and billing patients in a hospital environment of claim 13, wherein the patient ID is associated with a treatment location.

15. The method for accounting and billing patients in a hospital environment of claim 13, wherein the patient care service is provided from a location that is remote from the location of the hospitalized patient.

16. The method for accounting and billing patients in a hospital environment of claim 13, wherein the patient data are selected from the group consisting of patient identifying information, patient demographic information, patient admission data, patient laboratory results data, patient insurance data, patient guarantor information, a diagnosis code, attending physician data, and patient representative contact information.

17. The method for accounting and billing patients in a hospital environment of claim 13, wherein the patient data further comprises patient insurance data, and wherein patient insurance data comprises an insurance carrier ID, a plan name, a policy number, and a group number.

18. The method for accounting and billing patients in a hospital environment of claim 13, wherein the patient care service is selected from the group consisting of a doctor consultation, a follow-up patient visit, a time-related patient visit, a medical procedure, a diagnostic procedure, a laboratory procedure, administration of medication, and a surgical procedure.

19. The method for accounting and billing patients in a hospital environment of claim 13, further comprising verifying the billing data.

20. The method for accounting and billing patients in a hospital environment of claim 13, further comprising generating a patient stay summary.

21. The method for accounting and billing patients in a hospital environment of claim 13 further comprising submitting a claim form to an insurance carrier associated with the hospitalized patient.

22. The method for accounting and billing patients in a hospital environment of claim 13, wherein the billable service is provided by a physician, the method further comprising:

receiving a physician ID;

receiving physician insurance information and associating the physician insurance information with the physician ID; and

associating the provision of the billable service with the physician ID, and

wherein assembling the bill for the billable service for the hospitalized patient comprises associating the billable service with the physician using the physician ID and the physician insurance information.

23. The method for accounting and billing patients in a hospital environment of claim 22, wherein the physician ID is associated with physician identifying information, and wherein the physician identifying information comprises information selected from the group consisting of the physician'"'"'s name, the physician'"'"'s credentials, and the physician'"'"'s role in treating the hospitalized patient.

24. The method for accounting and billing patients in a hospital environment of claim 22, wherein the physician insurance information comprises a provider number and provider ID.

25. The method for accounting and billing patients in a hospital environment of claim 13 further comprising associating the billable service with a date of service.

28. The method for accounting and billing patients in a hospital environment of claim 13, wherein the telecommunications network is selected from the group consisting of a wired network, a wireless network, a cable network, a fiber optic network, and the Internet.

33. The method for accounting and billing patients in a hospital environment of claim 13 further comprising:

interfacing with an external network; and

providing a health care provider access to the remote command center via the external network.

34. The method for accounting and billing patients in a hospital environment of claim 33, wherein the external network is selected from the group consisting of a wired network, a wireless network, a cable network, a fiber optic network, and the Internet.

35. The method for accounting and billing patients in a hospital environment of claim 33, wherein the health care provider is selected from the group consisting of a physician, a nurse, a clinician, a diagnostician, and a intensivist.

36. The method for accounting and billing patients in a hospital environment of claim 33 further comprising sending the health care provider an alert if the patient-specific rule for the hospitalized patient has been contravened.