Registers – Systems controlled by data bearing records – Credit or identification card systems
Reexamination Certificate
2002-05-08
2003-12-02
Frech, Karl D. (Department: 2876)
Registers
Systems controlled by data bearing records
Credit or identification card systems
C235S375000, C235S477000, C235S383000, C705S003000, C705S002000, C705S001100, C705S041000, C705S038000
Reexamination Certificate
active
06655583
ABSTRACT:
FIELD OF THE INVENTION
The present invention relates to billing methods and systems, and, more particularly but not exclusively, to billing methods and systems for capturing and billing medical services and disbursements.
BACKGROUND OF THE INVENTION
Although, as indicated above, the present invention is not limited to such an application, the invention is of particular advantage in billing medical services and related charges. Further, the invention is particularly useful in billing medical services associated with the treatment of cancer, i.e., radiation treatments and the like.
With any billing system it is important to capture billing events, i.e., the dispensing of services rendered that are properly billable to the patient. In a cancer treatment setting, these events can include such services as patient consultation, treatment planning, simulations, dosimetry, devices, port verification, daily treatments, special dosimetry, special teleport, plans (identified by the code number 77321) and special Trx procedures (identified as 77470), ultrasound guided radiation treatment delivery and the like.
Conventional cancer billing typically involve the use of a record and verify system reports and/or the manual collection of charges from treatment documentation in order to create a “superbill” which includes all patient charges for a given treatment session or time period. The superbill is then used to input the charges into the billing system in a batch billing process to produce the invoices that are sent to both the insurance companies and the patients. One major disadvantage of such a system or approach is that record and verify systems are typically associated with equipment use (e.g., the use of the accelerator for radiation treatments) and the system does not capture all of the services for which the facility or doctor can legitimately bill.
More generally, record and verify systems are designed to capture billing for hospital/technical (diagnostic professional/technical) transactions, but there are many other process-based procedures performed that are billable by both the facility and the physician outside of these captured transactions. For example, IMRT (Intensity Modulated Radiation Therapy) can be considered to be a process-based procedure.
A further problem is that physicians are mandated by the Office of the Inspector General (OIG) to take responsibility for their charges and thus any billing system must ensure that only legitimate charges are billed and that these charges are accurately reflected in the corresponding billing statements. Batch billing, i.e., a billing system wherein all billing information for, e.g., a given month is collected together at the end of the month and then billed out at that time, is inefficient, and essentially inappropriate, for radiation oncology because of the shift in the field away from a transaction-based approach to a setting featuring (i) process-based patient care and (ii) serious insurance filing time constraints. In the latter regard, problems occur in filing insurance claims on time simply because batch billing is not real time billing. Further, as will appear, the standard requirements of insurance companies as to when successive treatments can be billed out result in further constraints on any billing system.
SUMMARY OF THE INVENTION
In accordance with the invention, a medical billing method and system are provided which overcome important disadvantages of medical billing systems currently in use. Although, as indicated above, the invention is not limited to such an application, the invention is particularly useful in billing for radiation treatments and associated procedures, medications and treatment accessories and equipment. The method of the invention provides an independent, automated approach to the capture of treatment events (e.g., individual radiation treatments). The invention results in efficient, complete accurate billing and documentation of charges (e.g., the charges of an oncology facility and physician) in real time and can be used in basically any treatment setting (e.g., with any radiation treatment unit). The independent charge capture provided helps ensure that payment is received for all properly billable services (e.g., all radiation oncology services) because accurate charge capture leads to accurate billing, resulting in faster payments, to prompt responses to erroneous insurance denials and, ultimately, to substantially higher collected revenue.
In accordance with one aspect of the invention, there is provided a billing method for billing for medical treatments, the method comprising: capturing a treatment event by electronically scanning, at the time of the treatment event, a machine readable patient identifier carried by a patient treatment chart having entered thereon a prescribed treatment; entering the captured treatment event into a computerized billing system along with the corresponding patient identifier; using said patient treatment chart to validate charges entered into computerized billing system; collecting all treatment events that are entered into the billing system; and generating an invoice for all of the collected treatment events entered into the billing system for the specific patient identifier.
Preferably, the patient treatment chart contains a prescribed schedule of treatments for the patient. Advantageously, in capturing a treatment event, an indication is provided as to whether or not a specific treatment of the prescribed schedule of treatments has been carried out. In an advantageous implementation, a dialog box is presented to a system user on a monitor located at the site at which the treatment event takes place; the dialog box presents choices corresponding to (i) full treatment, (ii) partial treatment and (iii) no treatment, and the user checks the appropriate box to indicate the treatment, if any, that was performed.
In a very important embodiment, the treatment event is entered into the treatment chart at the time the treatment takes place. It is much preferred that the treatment chart be updated in real-time as treatment events take place because the chart is the documentation used to validate charges being billed. In one preferred implementation, an independent treatment event capture system is used to inform the billing personnel when specific patients have reached a billable “milestone” as described below. However, even with the generation of a corresponding milestone report, the patient chart should be used to verify that the charges are appropriate before entering them into the billing system. Thus, even with a charge capture system, the patient chart should be used as a final verification mechanism.
Preferably, as indicated above, a milestone billing report is generated after a predetermined number of the treatment events is captured, and generation of a patient bill by the billing system takes place responsive to the generation of the milestone report. In an implementation tailored to current insurance practices in the United States, the billing system designates every fifth treatment event as a milestone for triggering generation of the milestone billing report. Preferably, the milestone billing report includes the patient name, milestone information, and bill date information for a given milestone, the bill date being the date of the first treatment of the milestone. Advantageously, when a full course of treatment for the patient is completed and the number of leftover unbilled treatments is not divisible by five, the billing system, in billing for the leftover treatments, treats the leftover treatments as a further milestone should there be three or more unbilled treatments, and again assigns the bill date as the date of the first treatment of the milestone. In an advantageous implementation, the billing system enables a user to log on to check whether the milestones are being properly reported. Preferably, this check is made by the billing system when a milestone is generated to check whether the milestones are being properly reported. Advantageously, t
Crowder, Jr. Robert Joseph
Walsh Christopher S.
Advanced Medical Interventions, Inc.
Frech Karl D.
Larson & Taylor PLC
Sanders Allyson
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