Device for automating billing reimbursement

Abstract

An apparatus for automating billing reimbursement includes an electronic handheld processing device that displays patient demographic information, billing codes and guideline information. The physician selects patient information and is able to sort the patient information by different categories. The physician, after examination of the patient, inputs a billing code which is outputted to an interface device for distribution to an information system for providing medical bills.

Description

RELATED APPLICATIONS [0001] This application is a continuation of U.S. application Ser. No. 09 / 356,543, filed Jul. 19, 1999, which claims the benefit of U.S. Provisional Application No. 60 / 100,333 filed on Sep. 15, 1998 and U.S. Provisional Application No. 60 / 093,446 filed Jul. 20, 1998, the entire teachings of which are incorporated herein by reference. A related application, U.S. application Ser. No. 09 / 356,751, filed Jul. 19, 1999 is incorporated herein by reference.BACKGROUND OF THE INVENTION [0002] The typical physician billing system that is used in most hospitals includes a physician carrying 3″×5″ cards, visiting a patient and afterwards assessing the extent of service performed and entering a diagnosis and procedure on the card, which determines the amount to be charged. The physician then provides the cards to the billing department. Although it sounds simple, there are many inefficiencies and hazards in this process that can result in unrealized revenue, lost revenue, and...

AI Technical Summary

Benefits of technology

[0021] In accordance with another aspect of the invention, a method for automating information processing includes electronically storing information in the handheld processing devices, indexing information by particular categories such as diagnosis, receiving updates of information and refreshing electronically stored information for easy access by a user.

[0022] The apparatus of the present invention has many applications, in the healthcare field, are in the legal field, in the financial field to name a few. For example, for the legal services, the present invention can assist automating the billing systems used by attorneys.

Problems solved by technology

Although it sounds simple, there are many inefficiencies and hazards in this process that can result in unrealized revenue, lost revenue, and fines from healthcare insurance reimbursement agencies.

The card approach has documentation problems such as overbilling and underbilling.

The difficulty is that these guidelines are confusing and change often.

For example, a physician may confuse the difference between “Initial Inpatient Consultation” and “Confirmatory Consultation,” or “Hospital Observation Services” and “Hospital Observation or Inpatient Care Services.” A mistake in this determination can lead to denied reimbursement and a possible fine (up to $10,000) per transaction.

But level 3 requires “medical decision making of high complexity” while level 2 requires only “moderate complexity.” A mistake in this choice can also lead to denied reimbursement and a possible fine.

Physicians are expected to remember and abide by these micro-managing guidelines but typically cannot.

This results in a huge loss of revenue for physicians, clinics, and hospitals, because the difference in price between two levels of service can be $20 or more.

Further, the card system suffers from billing latency (or “charge lag”) and lost cards.

The physicians have a habit of holding onto the paper cards for too long.

That is a long period of time for a large amount of money to remain in the insurance companies' coffers rather than the hospital's.

Again, records of services and procedures performed do not reach billing personnel.

In this case, it is simply because physicians have demanding schedules and it is often too inconvenient, difficult, or time-consuming to record billable events.

In summary, the existing paper-based billing card system has severe problems: Overbilling: Billing for too high a level of service means no reimbursement, possible fines, and wasted time re-submitting the insurance claim at a lower service level.

Underbilling: Billing for too low a level of service, while ensuring compliance with official billing regulations, means losses at least $20 per patient per visit.

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