Claims:We Claim:
1. A system and a method for real time or near real time charge capture, claim generation, claim adjudication, and collection of payment from patient where
a. The system consists of an electronic network of a kiosk or a plurality of kiosks, a computer or a plurality of computers for collaborative interaction between provider, coder and patient, one or a plurality of computer servers and electronic networks
b. The method consists of an electronic semi-automated collaborative process between a physician and a coder or a coding system for generation of charges during the encounter, the generation of claim(s), submission of claim(s) to payer(s) for real time adjudication, the reception of EOB(s) from payer(s), computing the patient payment amount from the EOB(s) and collection of patient payment at a check out kiosk (or a computer or a mobile device).
2. The method of claim 1, where the construction of the claim from the charges is performed in real time during the patient encounter.
3. The method of claim 2, wherein bundling of procedure codes in the claim(s) is performed for various business reasons in an automated or semi-automated fashion.
4. The method of claim 1, wherein there is a plurality of providers treating a patient during an encounter.
5. The method of claim 1, wherein one or a plurality of steps are performed manually or modified or skipped or their execution order is changed to suite business needs.
, Description:Technical Field of the Invention
Our invention consists of a system and a method for real time billing, adjudication and collection of payments from payer(s) and patients during a patients' encounter with a healthcare provider.
Background of the Invention
Billing for healthcare services is a time consuming, laborious, error prone and costly process. In the typical paper driven manual processes currently in vogue, the claim generation, submission, and adjudication are post processing steps that are done after a patient encounter is completed. During the encounter, the provider accumulates the details of diagnosis found and procedures provided in a superbill. The superbill is handed over to the billing department or a third-party billing company to create one or more healthcare claims. The superbill is often handed over on paper. The billing personnel create claims using one of several appropriate formats. The billing personnel typically need to re-enter data about the patient encounter, including but not limited to the demographics of the patient, the dates of the encounter, the diagnostics code(s) and the procedure code(s), and any referral/authorization if applicable. The handover of superbills is often done on a weekly basis involving several days of delay. The creation of the claim itself can take several days. The claim(s) is (are) then submitted to the payer or multiple payers if appropriate for adjudication. Several payers support electronic means for submitting claims. The payer adjudicates the claim and returns an explanation of benefits and a payment to the provider. The two may happen separately, electronically or manually, and can take several days or weeks. The provider then figures the difference in payment received and sends paper statements or electronic statements for collecting the patient liability from the patient. This is then submitted to the patient along with relevant EOB, typically on paper or via a bill pay website. The patient then may send a payment to the provider. In the United States, there are often complications and confusion resulting from multiple payers, from per incident and annual deductibles associated with healthcare plans, and from eligibility and order of precedence associated with healthcare plans. The entire process can potentially take several days or several months. This extends the collection time for healthcare providers into several days or months. Delays and errors often lead to a percentage of healthcare services not being paid at all. It is desirable to automate the process and speed up the process of generation and submission of claims from the provider's point of view as well as from the coder's point of view. More importantly our invention makes it very clear to the patient their liability at the time of service and lets the patient pay their portion at the same time.
There are several mechanisms mentioned in prior art dealing with the real time, near real time or electronic process for submission and/or adjudication of healthcare claims to payers. Our invention can work in concert with or interfacing with one or more such payer claims processing systems. Our invention can also work in conjunction with practice management systems and electronic medical record (EMR) systems, patient check-in systems and patient admission, discharge and transfer (ADT) systems, financial accounting systems and other healthcare IT systems mentioned in prior art.
There are several solutions proposed for real time claims adjudication and payment in prior art. Most of them work with electronic backend submission mechanisms being enabled by payers. They propose electronic means for submitting a claim from a provider to a payer and receiving an acknowledgment or explanation of benefits in response back to the provider. When the patient information and procedure codes from a claim are entered into the POS, the POS sends an electronic claim to a payer's backend system that it is prewired into, gets and explanation of benefits (EOB) as a response and presents the EOB to the patient to collect the patient portion of the payment if there is any. The critical difference in our invention is the ability to provide the EOB to the patient via a kiosk at check-out as well as the ability for the coder to create the charges collaboratively in real time while the provider is interacting with the patient, the coder generating the claim(s) from charges, and the coder submitting the claim(s) in real time or near real time.
Object of the Invention
The present object of the invention is to System and Method for real time healthcare billing and collection in a Kiosk.
Summary of the Invention
The current process for generating healthcare claims for an encounter is time consuming and involves manual paper-based processes. The current process can take several days before a claim is generated and the patient liability is sent to the patient by means of a patient statement via postal mail or email. Our invention replaces this with a semi-automated real time collaborative process, with an electronic computer network connecting the provider to a coder, where the entire process is run in real time during the patient's encounter. It enables the provider to send the charge capture information required for billing in real time to a coder. The coder and/or the system then prepare the list of charges collaboratively with the provider, prepare a claim or a plurality of claims and submit them on the provider's behalf to the payer(s). The system consists of a computer or a several computers or a handheld device or several handheld devices or a kiosk or several kiosks, and a server or several servers, all connected by an electronic computer network to enable real time communication. The method consists of enabling the provider to enter diagnosis and procedure codes in real time during the encounter, to collaborate with a coder/system to produce the charges and subsequently the claim(s) and to submit the claim at the end of the encounter to the payer(s). Subsequently, if appropriate, the method continues to near real time adjudication of the claim by the payer or a plurality of payers, the presentation of the explanation of benefits (EOB) to the patient and the patient liability including coinsurance, deductibles, and co-payment(s) may be collected from the patient at the point of check-out via a check-out kiosk (mobile device/computer system). Our invention increases the efficiency and reduces the time taken by healthcare providers in generating claims for encounters and collecting payments, thereby improving their revenue(s) and the revenue cycle of the practice.
Brief Description of Drawings
FIG. 1 illustrates a specific embodiment of our invention, where our system provides a method to collect patient's obligation at a kiosk during check-out.
Detailed Description of Invention
FIG. 1 illustrates the process for collection of patient's obligations at a kiosk in an embodiment of our invention. The patient is directed to a check out kiosk at the end of the encounter. The patient is requested to identify himself/herself. If the patient cannot be successfully identified or if the EOB is not available, then he/she is directed to go to the front desk for further processing (and the front desk is optionally notified). If the patient is identified and the EOB is available, the amount of patient's obligation is computed and/or estimated based on the EOB information available. If payer supports real time adjudication, the amount of patient obligation due to deductible(s), co-insurance(s), etc., can be computed. This is presented to the patient. The kiosk may be provisioned to accept payment by one or more means, including cash, check, credit card, debit card, benefits card, bill-me-later service, etc. The options available are presented to the patient and the payment is collected from the patient. The amount collected is posted to the accounting system.
We described specific embodiments of the invention along with specific examples in the specific domain of healthcare. Practitioners of the art can apply our invention to several other examples that may differ in several ways from the examples we discussed, including but not limited to the type of encounter, the type of appointment or procedure, the details of the information available, etc. Practitioners of the art can derive several embodiments and domains of applicability of our invention. An alternate embodiment of the invention may not use a kiosk. Yet another alternate embodiment of the invention may not use a backend IT system or may use one or more backend IT systems and/or other systems. Practitioners of the art can apply our invention to such alternate embodiments.