Patient credit balance account analysis, overpayment reporting and recovery tools
View Patent ↗The present invention provides a system for managing, analyzing and reporting accounts of overpaid claims for patient balance accounts, although various components and features of the system are inventions into themselves. Certain aspects of the inventor allow managers of both service providers (such as health care facilities) and payers (such as insurance companies and Medicare) to assign work and produce reports. Other aspects of the invention allow provider users and payer users to analyze and resolve the claims in an automated environment. These aspects provide the users with information in a readily accessible and easy to navigate format. The users are also provided with tools for analyzing the claims in an automated manner.
1. A method of processing patient credit balance accounts, the method, comprising the steps of:
reviewing transactions in a patient account having a credit balance, by a processing device, to identify indicators related to the transactions in the patient account;
establishing a plurality of scoring levels wherein each scoring level includes a plurality of criteria;
applying the criteria levels to the identified indicators;
assigning, by the processing device, a numerical score to the patient account, using the applied criteria, which represents an expected difficulty of resolving the credit balance; and
assigning, by the processing device, a possible resolution to the patient account which indicates a cause of the credit balance based on the assigned numerical score.
2. The method of claim 1 , further comprising:
assigning, by the processing device, an account designation to the patient account having a credit balance based on the identified indicators, wherein the steps of assigning the account designation and assigning the possible resolution comprise an advanced scoring module (ASM) using the identified indicators to assign the account designation and to assign the possible resolution to the patient account in a consistent fashion.
3. The method of claim 2 , wherein the step of assigning the account designation includes designating the patient account as a Medicare account if any Medicare payments are identified.
4. A method of processing patient credit balance accounts using a processing device, comprising the steps of
reviewing transactions in a patient account having a credit balance, by a processing device, to identify indicators related to the transactions in the patient account;
establishing a plurality of scoring levels wherein each scoring level includes a plurality of criteria;
applying the criteria in the plurality of scoring levels to the identified indicators;
assigning, by the processing device, a numerical score to the patient account, using the applied criteria, which represents at least an expected difficulty of resolving the credit balance; and
assigning, by the processing device, a possible resolution to the patient account which indicates a cause of the credit balance based on the assigned numerical score.
5. The method of claim 4 , further comprising:
assigning, by the processing device, an account designation to the patient account having a credit balance based on the identified indicators; and
the step of assigning the patient account to an adjuster based on the score assigned to the patient account.
6. A method of automatically processing patient credit balance accounts for a provider to identify patient overpayments comprising the steps of
reviewing transactions in patient accounts each having a credit balance, by a processing device, to identify indicators related to the transactions in each of the patient accounts;
establishing a plurality of scoring levels, wherein each scoring level includes a plurality of criteria;
applying the criteria in the plurality of scoring levels to the identified indicators;
assigning, by the processing device, a numerical score to the patient account, using the applied criteria, which represents an expected difficulty of resolving the credit balance;
selecting a patient account having a credit balance, by the processing device, caused by a patient overpayment based on the assigned numerical score; and
posting a patient refund by the processing device, which corrects the credit balance, to a data file corresponding to the patient account.
7. The method of claim 6 , further comprising the step of encrypting the data file and transmitting the data file, by the processing device, to an accounting system.
8. The method of claim 7 , further comprising the step of transmitting, by the processing device, the data file to a third party financial institution that will issue the patient refund for the provider.
9. The method of claim 6 , further comprising the step of preparing a summary report identifying each posted patient refund, by the processing device.
10. The method of claim 9 , further comprising the step of electronically transmitting, by the processing device, the summary report to a recipient designated by the provider.
11. The method of claim 6 , further comprising the steps of:
saving, by the processing device, the identified indicators so that the identified indicators are correlated to the patient account; and
assigning, by the processing device, a possible resolution to the patient account which indicates a cause of the credit balance based on the identified indicators.
12. The method of claim 11 , further comprising the steps of:
assigning, by the processing device, an account designation to the patient account having a credit balance based on the identified indicators; and
assigning, by the processing device, the patient account to an adjuster based on the score assigned to the patient account.
13. A method of automatically processing patient credit balance accounts for a provider to identify misposted payments comprising the steps of:
reviewing transactions in patient accounts each having a credit balance, by a processing device, to identify indicators related to the transactions in each of the patient accounts;
establishing a plurality of scoring levels, wherein each scoring level includes a plurality of criteria;
applying the criteria in the plurality of scoring levels to the identified indicators;
assigning, by the processing device, a numerical score to the patient account, using the applied criteria, which represents an expected difficulty of resolving the credit balance;
selecting, by the processing device, a patient account having a credit balance caused by a misposted payment based on identified indicators;
determining, by the processing device, corrective transactions necessary to correct the misposted payment; and
posting, by the processing device, the corrective transactions to a data file corresponding to the patient account.
14. The method of claim 13 , further comprising the step of encrypting the data file and transmitting the data file, by the processing device, to an accounting system.
15. The method of claim 13 , further comprising the step of preparing, by the processing device, a summary report identifying each of the corrective transactions.
16. The method of claim 15 , further comprising the step of electronically transmitting, by the processing device, the summary report to a recipient designated by the provider.
17. The method of claim 13 , further comprising the steps of
saving identified indicators so that the identified indicators are correlated to the patient account; and
assigning, by the processing device, a possible resolution to the patient account which indicates a cause of the credit balance based on the identified indicators.
18. The method of claim 17 , further comprising the steps of:
assigning, by the processing device, an account designation to the patient account having a credit balance based on the identified indicators; and
assigning, by the processing device, the patient account to an adjuster based on the score assigned to the patient account.
19. A method of automatically processing patient credit balance accounts for a provider to identify misposted adjustments comprising the steps of:
reviewing transactions in patient accounts each having a credit balance, by a processing device, to identify indicators related to the transactions in each of the patient accounts;
establishing a plurality of scoring levels wherein each scoring level includes a plurality of criteria;
applying the criteria in the plurality of scoring levels to the identified indicators;
assigning, by the processing device, a numerical score to the patient account, using the applied criteria, which represents an expected difficulty of resolving the credit balance;
selecting, by the processing device, a patient account having a credit balance caused by a misposted adjustment based on the identified indicators;
determining, by the processing device, a corrective transaction necessary to correct the misposted adjustment; and
posting, by the processing device, the corrective transaction to a data file corresponding to the patient account.
20. The method of claim 19 , further comprising the step of encrypting the data file and transmitting the data file, by the processing device, to an accounting system.
21. The method of claim 19 , further comprising the step of preparing, by the processing device, a summary report identifying each of the corrective transactions.
22. The method of claim 21 , further comprising the step of electronically transmitting, by the processing device, the summary report to a recipient designated by the provider.
23. The method of claim 19 , further comprising the steps of:
saving, by the processing device, the identified indicators so that the identified indicators are correlated to the patient account; and
assigning, by the processing device, a possible resolution to the patient account which indicates a cause of the credit balance based on the identified indicators.
24. The method of claim 23 , further comprising the steps of:
assigning, by the processing device, an account designation to the patient account having a credit balance based on the identified indicators; and
assigning, by the processing device, the patient account to an adjuster based on the score assigned to the patient account.