System and method for managing account receivables
A system for managing account receivables is provided. The system comprises a rules module or engine for receiving at least one encounter from a first party and for assessing the at least one encounter based on rules associated with a payer; and a transactions module or engine for outputting at least one claim to the payer based on the rule module's assessment of the at least one encounter.
1. A system for managing account receivables, comprising:
a rules module or engine receiving at last one encounter from a first party and assessing the at least one encounter based on rules associated with a payer;
a transaction module or engine: (1) converting the at least one encounter to at least one claim; (2) providing the first party with an estimated value of the at least one claim to the payer, wherein the estimated the value comprises an estimated payment amount that the first party is likely to receive as payment from the payer for services rendered, and wherein the estimated payment is determined from corresponding historical and current payment patterns of the payer, and (3) outputting the at least one claim to the payer based on the rule module's assessment of the at least one encounter;
a remittance processing module or engine: (1) receiving and processing at least one remittance from the payer, wherein the at least one remittance comprises at least one payment on the at least one claim, (2) comparing the at least one payment to the estimated value of the at least one claim, (3) posting the at least one payment against the at least one claim, (4) generating an underpayment incident if the estimated value is more than the at least one payment, wherein the underpayment incident comprises the difference between the estimated value and the at least one payment; (5) revising the estimated value if the at least one payment is greater than the estimated value, and (6) posting the underpayment incident as a denial to a reimbursement management module or engine for collection.
2. The system of claim 1 , where in the rule module's assessment comprises posting the at least one encounter to a transaction table.
3. The system of claim 1 , wherein the rules module or engine rejects the at least one encounter if it does not comply with the rules associated with the payer.
4. The system of claim 1 , wherein the at least one remittance further comprises at least one denial, wherein the at least one denial is posted to the reimbursement management module or engine for collection.
5. The system of claim 1 , further comprising a nightly aging module or engine for aging accounts receivables on a nightly basis.
6. The system of claim 4 , reimbursement management module or engine organizes the at least one denial into an efficient configuration.
7. The system of claim 6 , wherein the reimbursement management module or engine further assesses at least one of a denial incident, a no-response incident, an underpayment incident, and a patient past due incident.
8. An automated method for managing accounts receivables, wherein the method is executed by a programmed computer processor which communicates with a user via a network, the method comprising the steps of:
posting an encounter to a transaction table using the programmed computer processor, wherein the encounter is submitted by a user via the network;
processing the encounter using the programmed computer processor to determine an estimated value amount from a payer, wherein the estimated value comprises estimated payment amount that the first party is likely to receive as payment from the payer for services rendered, and wherein the estimated payment is determined from corresponding historical and current payment patterns of the payer;
presenting a first claim and second claim based on the encounter to the payer;
receiving a remittance from the payer, wherein the remittance comprises a payment on the first claim and a denial of the second claim;
comparing the remittance to the estimated payment using the programmed computer processor; and
posting the remittance to the transaction table using the programmed computer processor, wherein the payment on the first claim is applied against the first claim and the denial of the second claim is submitted to a reimbursement management engine for collection.
9. An automated method for managing account receivables, wherein the method is executed by a programmed computer processor which communicates with a first party via a network, the method comprising the steps of:
receiving at least one encounter from a first party via the network, wherein the at least one encounter relates to services rendered by the first party;
assessing the at least one encounter based on rules associated with a payer;
converting the at least one encounter to at least one claim using the programmed computer processor;
determining an estimated value of the at least one claim to the payer using the programmed computer processor, wherein the estimated value comprises an estimated payment amount that the first party is likely to receive as payment from a payer for services rendered, and wherein the estimated payment is determined from corresponding historical and current payment patterns of the payer;
outputting the at least one claim to the payer;
receiving at least one remittance from the payer, wherein the at least one remittance comprises at least one payment on the at least one claim;
comparing the at least one payment to the estimated value of the at least one claim;
posting the at least one payment against the at least one claim;
generating an underpayment incident if the estimated value is more than the at least one payment, wherein the underpayment incident comprises the difference between the estimated value and the at least one payment;
revising the estimated value if the at least one payment is greater than the estimated value; and
posting the underpayment incident as a denial for collection.
10. The automated method of claim 9 , wherein the comparison step occurs after the payment is received.