# US 2017/0286607 A1 · Automated workflow in emergency medical services billing

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- Number: US 2017/0286607 A1
- Document ID: US20170286607A1
- Status: Published application
- Kind: A1
- Application number: 15/471,310
- Filed: 2017-03-28
- Published: 2017-10-05
- Earliest claimed: 2016-03-31
- Assignees: ZOLL Medical Corporation
- Applicants: ZOLL Medical Corporation
- Inventors: Donna Magnuson; Lawrence Collins Werner, JR.; Jason Haggstrom; Justin Jacoby
- Web page: https://patentgrep.com/patent/US20170286607A1

## CPC

- G06Q 40/08: Insurance
- G06Q 10/10: Office automation; Time management
- G16H 10/60: for patient-specific data, e.g. for electronic patient records
- G06Q: INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
- G16H: HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA

## Abstract

Techniques for automation of medical claim processing are disclosed. In one embodiment, the techniques may be realized as a system for automatically processing emergency medical claims, comprising: one or more processors and a memory. The memory may contain instructions that, when executed by the processor, cause the processor to: receive an emergency medical claim; determine a status code corresponding to a current status of the claim and a reason code corresponding to a reason for the current status of the claim; and identify, based on the status code and the reason code, a task that needs to be completed on the claim and an administrator associated with and/or responsible for handling the task.

## Claims

### Claim at position 1

1-20. (canceled)

### Claim 21

A system for automatically processing emergency medical claims, the system comprising:
a payer plan database storing payer plan information;
one or more processors, and a memory, the memory containing instructions that, when executed by the processor, cause the processor to:
receive an emergency medical claim;
identify a payer of the claim based on information provided in the claim;
determine an expected claim payment amount to be collected from the payer based on one or more medical services listed in the claim;
adjust the expected claim payment amount based on at least one of a payment schedule of the payer, a past payment of the payer for a same type of claim, patient eligibility, patient co-payment, patient deductible, patient co-insurance, and a determined collection risk.

### Claim 22 (depends on 21)

The system according to claim 21, wherein the payer plan database is configured to store data populated based on contractual terms for the payer.

### Claim 23 (depends on 21)

The system according to claim 21, wherein the memory further includes instructions that, when executed by the processor, further cause the processor to adjust the claim payment amount if a payment of the claim has been posted such that a payment discrepancy exists between the posted payment and the expected claim payment amount.

### Claim 24 (depends on 21)

The system according to claim 21, wherein the memory further includes instructions that, when executed by the processor, further cause the processor to adjust the expected claim payment amount if a payment of the claim is not received within a time period after the claim is submitted to the payer.

### Claim 25 (depends on 21)

The system of claim 21, wherein the memory further includes instructions that, when executed by the processor, further cause the processor to write-off the claim and forward the claim to an outside collection agency.

### Claim 26

A system for automatically processing emergency medical claims, the system comprising:
one or more processors and a memory, the memory containing instructions that, when executed by the processor, cause the processor to:
receive an emergency medical claim;
identify a payer of the claim; and
determine an amount to be collected from the payer, based on a payment schedule of the payer, wherein the payment schedule of the payer is associated with a third party.

### Claim 27 (depends on 26)

The system according to claim 26, wherein the third party is at least one of Medicare or Medicaid.

### Claim 28 (depends on 26)

The system according to claim 26, wherein the one or more processors are further configured to update the payment schedule of the payer according to a payment schedule update of the third party.

### Claim 29

A system for automatically processing emergency medical claims, the system comprising:
one or more processors and a memory, the memory containing instructions that, when executed by the processor, cause the processor to:
receive an emergency medical claim;
identify a payer of the claim; and
determine an amount to be collected from the payer, based on a past payment of the payer for a same type of claim.

### Claim 30 (depends on 29)

The system according to claim 29, wherein the memory further includes instructions that, when executed by the processor, further cause the processor to submit the emergency medical claim to the payer for payment.

### Claim 31 (depends on 29)

The system according to claim 29, wherein the memory further includes instructions that, when executed by the processor, further cause the processor to adjust the amount to be collected from the payer if there are a plurality of payers for the claim.

### Claim 32 (depends on 29)

The system according to claim 29, wherein the memory further includes instructions that, when executed by the processor, further cause the processor to adjust the amount to be collected from the payer based on at least one of patient eligibility, patient co-payment, patient deductible, or patient co-insurance.

### Claim 33 (depends on 29)

The system according to claim 29, wherein the memory further includes instructions that, when executed by the processor, further cause the processor to adjust the amount to be collected from the payer based on a payment schedule of the payer, wherein the payment schedule of the payer is associated with a third party.

### Claim 34 (depends on 29)

The system according to claim 29, wherein the memory further includes instructions that, when executed by the processor, further cause the processor to determine a collection risk of the amount to be collected.

### Claim 35 (depends on 29)

The system according to claim 29, wherein the memory further includes instructions that, when executed by the processor, further cause the processor to determine an amount that has been received from the payer and identify a discrepancy between the amount to be collected and the amount that has been received.