# US 2021/0241378 A1 · Automated workflow in emergency medical services billing

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- Number: US 2021/0241378 A1
- Document ID: US20210241378A1
- Status: Published application
- Kind: A1
- Application number: 17/183,060
- Filed: 2021-02-23
- Published: 2021-08-05
- Earliest claimed: 2016-03-31
- Assignees: ZOLL Medical Corporation
- Applicants: ZOLL Medical Corporation
- Inventors: Donna Magnuson; Lawrence Werner, JR.; Jason Haggstrom; Justin Jacoby
- Web page: https://patentgrep.com/patent/US20210241378A1

## 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

In one aspect, a system for automatically processing a medical claim includes a billing automation platform, a navigation device with a global positioning system for collecting patient transport information including a location of a medical encounter, and a computing device for receiving the patient transport information and patient charting information and transmitting the information for use by the billing automation platform. The billing automation platform may access fee schedule(s) based on a location of the medical encounter, automatically populate the medical claim based on the patient charting information, the patient transport information, and the fee schedule(s), and automatically route the medical claim through workflow paths of a claim processing workflow.

## Claims

### Claim at position 1

1-35. (canceled)

### Claim 36

A system for automatically processing a medical claim, the system comprising:
one or more servers configured to implement a billing automation platform;
a navigation device associated with a patient transport vehicle and comprising a global positioning system (GPS), the navigation device configured to collect patient transport information comprising a location of a medical encounter; and
a computing device communicably coupled to the navigation device and to the one or more servers, the computing device configured to
receive the patient transport information from the navigation device,
receive patient charting information for the medical encounter, and
transmit the patient transport information with the patient charting information to the one or more servers,
wherein the billing automation platform is configured to
receive the patient transport information with the patient charting information,
access at least one fee schedule based on the location of the medical encounter,
automatically populate the medical claim for the medical encounter based on the patient charting information, the patient transport information, and the at least one fee schedule, and
automatically route the medical claim through a plurality of workflow paths of an automated claim processing workflow, wherein routing the medical claim comprises
(a) associating the medical claim with first routing information comprising a first status code and a first reason code of a plurality of status codes and a plurality of reason codes based at least in part on the medical claim,
(b) directing the medical claim through a first workflow path of the plurality of workflow paths based on the first routing information, wherein the directing results in the first routing information being updated to a next routing information comprising a next status code and a next reason code of the plurality of status codes and reason codes,
(c) directing the medical claim through a next workflow path of the plurality of workflow paths based on the next routing information, and
(d) repeating step (c) for the plurality of workflow paths.

### Claim 37 (depends on 36)

The system of claim 36, wherein the patient charting information comprises an electronic patient care record (ePCR).

### Claim 38 (depends on 37)

The system of claim 37, wherein the computing device comprises a mobile device.

### Claim 39 (depends on 38)

The system of claim 38, wherein the mobile device comprises a smartphone or a tablet.

### Claim 40 (depends on 38)

The system of claim 38, wherein the mobile device comprises at least one of a touch screen or voice recognition data entry.

### Claim 41 (depends on 38)

The system of claim 38, wherein the mobile device is communicably coupled to a patient monitor and/or defibrillator.

### Claim 42 (depends on 36)

The system of claim 36, wherein the billing automation platform is configured to automatically update one or more fee schedules of the at least one fee schedule based on a third-party fee schedule update.

### Claim 43 (depends on 42)

The system of claim 42, wherein the third-party fee schedule update is a Medicare or a Medicaid fee schedule update.

### Claim 44 (depends on 36)

The system of claim 36, wherein the billing automation platform is configured to determine an expected claim payment amount for the medical claim.

### Claim 45 (depends on 44)

The system of claim 44, wherein the billing automation platform is configured to access a plurality of claim payment information comprising at least one of patient health insurance information, patient co-insurance information, patient deductible information, or patient eligibility information.

### Claim 46 (depends on 44)

The system of claim 44, wherein the billing automation platform is configured to determine the expected claim payment amount for the medical claim based on a payment history of a payer for a same type of medical claim or a similar type of medical claim.

### Claim 47 (depends on 44)

The system of claim 44, wherein the billing automation platform is configured to determine the expected claim payment amount based on a determined collection risk for the medical claim.

### Claim 48 (depends on 36)

The system of claim 36, wherein the billing automation platform is configured to verify first demographic information.

### Claim 49 (depends on 48)

The system of claim 48, wherein the billing automation platform is configured to query for additional patient demographic information based on the first demographic information.

### Claim 50 (depends on 36)

The system of claim 36, wherein the billing automation platform is configured to analyze content of the medical claim for completeness and accuracy.

### Claim 51 (depends on 36)

The system of claim 36, wherein each status code of the plurality of status codes corresponds to two or more reason codes of the plurality of reason codes.

### Claim 52 (depends on 36)

The system of claim 36, wherein each status code of the plurality of status codes and each reason code of the plurality of reason codes corresponds to a respective role or a plurality of roles.

### Claim 53 (depends on 36)

The system of claim 36, wherein the one or more servers configured to implement the billing automation platform are configured to communicably couple to one or more dispatch servers.

### Claim 54 (depends on 53)

The system of claim 53, wherein the one or more servers configured to implement the billing automation platform are configured to communicably couple to the one or more dispatch servers to access emergency dispatch information.

### Claim 55 (depends on 36)

The system of claim 36, wherein the one or more servers are configured to implement the billing automation platform as part of a cloud computing environment.

### Claim 56 (depends on 36)

The system of claim 36, wherein the billing automation platform is configured to identify pre-authorization requirements.

### Claim 57 (depends on 36)

The system of claim 36, wherein the billing automation platform is configured to determine medical claim payment information based on a geographic location of a patient.