System and method for managing account receivables
AssigneeAvisena, Inc.
InventorsAlbert Santalo, Ben Sardinas, Allan Pacheco, Jihad Stephens
Life of this patent
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Abstract
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.
Claims33
A system for managing account receivables, comprising:
- 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.
A method for managing account receivables, comprising:
- inputting at least one encounter into a capture screen;
- transforming the at least one encounter into at least one transaction;
- posting the at least one transaction to a transaction table;
- pulling at least one charge from the at least one transaction;
- assembling the at least one charge;
- comparing the at least one charge based on client billing parameters and payer parameters;
- building at least one batch of the at least one charge based on payer and/or media;
- and
- outputting the at least one batch to at least one payer.
A method for managing reimbursement incidents, comprising:
- receiving at least one incident;
- and
- working the at least one incident based on who generated the incident, the type of incident, the type of payer, the incident reason, the available resources for working the at least one incident.
A method for managing accounts receivables, comprising:
- posting an encounter to a transaction table;
- processing the encounter to determine likelihood of receiving payment;
- presenting encounter to a payer;
- receiving a remittance from the payer;
- and
- posting the remittance to the transaction table.
A method for processing collection incidents, comprising:
- receiving at least one aged collection incident;
- receiving at least one new collection incident;
- grouping the at least one aged collection incident and the at least one new collection incident in a desired order;
- and
- working the at least one aged collection incident and the at least one new collection incident in the desired order.
A method for classifying accounts receivable, comprising:
- evaluating information on a receivable;
- determining the payer associated with the receivable;
- determining past payment patterns of the payer;
- and
- aging the account receivable.
A method for validating incoming encounters, comprising:
- receiving an encounter from a provider, the encounter containing information related to services rendered to a patient;
- evaluating the information contained in the encounter based on specified rules;
- determining whether the encounter is invalid;
- and
- permitting the encounter to be amended if the encounter is invalid.
The invalid encounter is invalid because it is not likely to get paid.
The invalid encounter is invalid because the procedure(s) could not have been performed on the patient and/or the diagnosis(s)could not have been reached at the time of the encounter.
A method for valuing a service line or charge, comprising:
- receiving at least one encounter from a provider;
- posting the encounter as a service line or charge;
- assigning a value to the service line or charge based on reimbursement information for a payer and/or provider.
A method for retrieving and posting reimbursement information from a payer, comprising:
- receiving at least one remittance from a payer;
- determining the type of remittance;
- validating and balancing the remittance;
- adding additional information relating to the remittance to enhance collection;
- posting the remittance, including all payments, denials, comments, remarks, memos, adjustments, instructions for subsequent payment, and any other information useful for collection;
- and
- reconciling and/or reassigning any outstanding balances based on the remittance.
A method for creating and maintaining a global insurance library, comprising:
- identifying if a new insurance information is encountered;
- creating the new insurance;
- maintaining insurance information in the library;
- queuing the new insurance;
- reviewing the new insurance information to ensure it is not a duplicate, capturing the new insurance information;
- and
- merging the new insurance information to the global insurance library to include in progress work that references reviewed insurance information.
Dependencies are inferred from the claim text.