Integrated medical software system with patient pre-approvals

Abstract

An integrated medical software system with a patient registration software component executed by a processor of the system to capture patient information is disclosed. The system and method comprise a section where demographic data is input for the patient, said demographic data including at least one of a digital photograph, a name, an address, a date of birth, a social security number, and a sex of the patient; a section where financial data is input for the patient, said financial data including at least one of financial responsibility, outstanding balances, insurance coverage, insurance claims currently being processed, and account information of the patient; and a section where administrative data is input for the patient, said administrative data including at least one of scheduling information, reminders and alerts, visit check-in and check-out, and system preferences for the patient, wherein the patient is pre-approved for at least one of a referral, a hospital admission, a clinician's order, a medical procedure, or a medication that would otherwise require prior approval based on at least one of the demographic data, the financial data, and the administrative data.

Description

RELATED APPLICATIONS[0001]The present application is a continuation of co-pending U.S. patent application Ser. No. 10 / 202,627, filed Jul. 25, 2002, which claims priority to Provisional Application Ser. No. 60 / 373,662, filed Apr. 19, 2002, the entire contents of which are incorporated herein by reference.BACKGROUND OF THE INVENTION[0002]Service professionals that regularly schedule patient visits have historically relied upon manual practice management, patient records and managed care (i.e., insurance) techniques. For instance, scheduling patients, tracking prescription orders, and maintaining file documentation are typically performed through paper calendars and files. An office assistant receives and schedules patient appointments on the paper calendar. The service professional then checks the paper schedule for each day.[0003]For purposes of this application, service professionals may include, for instance, healthcare providers such as physicians (MD or DO), dentists, chiropracto...

AI Technical Summary

Benefits of technology

[0020]Accordingly, it is an object of the invention to provide a medical software system that integrates all aspects of practice management and managed care, including schedule management, patient registration, insurance information, and billing and collections, with the EMR. It is another object of the invention to provide a practice management system that is secure, has functionality and usability, tracks work flow for service professionals, and makes the best use of manual resources. It is yet another object of the invention to provide a practice management system that is cost effective to implement and maintain, even for small practice groups (2-5 clinicians), but is configurable to meet the needs of various specialties.

[0021]In accordance with these and other objectives, a medical management system is provided that integrates all aspects of healthcare provider practice management and managed care, including schedule management, patient registration, insurance information, and billing and collections with the EMR. The system integrates a central framework module, a scheduling module, a registration component, an account management module, and clinical module to provide a seamless exchange of information.

[0022]The clinical module provides an administration builder that allows users to define a customized template. The templates are used by a document builder to generate documents, such as progress notes and H&P Notes, which are retained in the patient's electronic chart. The progress note template allows the clinician to record a patient encounter by presenting the clinician with predefined sections and sentences that are easily completed by the clinician during or after the patient encounter. The templates and documents generated are designed to closely resemble a paper chart. Information gathered during patient scheduling, registration, triage, and previous encounters are referenced to pre-populate the templates to avoid having the clinician entering redundant information. The documents are relied upon to automatically generate charges, from which electronic requests are sent to a claims clearinghouse.

[0023]The system results in increased revenue due to coding accuracy, billing and fee schedule cross referencing to reduce under-payments and over-payments, writeoffs, improved clinician productivity, improved claims management and payment reconciliation of under payments, patient care reminders that generate preventive / preventative care visits, and improved receivables collections. The system results in a reduction of cost, such as a reduction in the cost of copying and storing documents and records, malpractice insurance premiums, transcription costs, paper and related supplies, rejected claims and costs associated with claims reprocessing, labor savings due to efficiencies and resulting in possible staff reduction or redeployment, and decreased repeated lab tests.

[0024]The system has intangible clinical advantages, such as improved quality of patient care through the provision of preventive / preventative care, improved chart availability, drug / allergy interaction alerts, outcomes analysis, improved response time for patient information requests, improved clinician and administrator satisfaction, reduction in paperwork and increased available time to spend with patients. Intangible business benefits include more efficient scheduling and appointment notification, avoidance of misplaced or lost patient record files, elimination of redundant data management, improved financial accounting accuracy and reporting, and increased market share. The system is efficient with respect to chart pulls, referral coordination, billing documentation compliance, coding compliance and lab report filing.

Problems solved by technology

However, manual practice management, patient record and managed care techniques are inefficient since they require a great deal of interaction between the service professional and the office assistant.

Last minute scheduling changes often result in lost time for the service professional.

In addition, manual tracking is prone to error and the large amounts of paper that is generated take up valuable office space.

Clinician orders that often generate billable procedures are difficult to process because they are written by hand and in many cases are omitted from the patient's bill.

In addition, handwritten orders for prescriptions have been identified as the number one cause of medical errors resulting in patient death in the United States.

Add to these issues the complexity of insurance contracts and procedure fee schedules that govern the amount which clinicians are to be paid for their services, and the result is a very inefficient, labor-intensive process requiring many checks and balances to ensure accurate processing.

The amount of paperwork required has a significant impact on the service professional, which often detracts from the amount of time the service provider can spend with the patient.

In skilled nursing care, every hour of patient care results in 30 minutes of paperwork.

And, in home health care, every hour of patient care results in 48 minutes of paperwork.

In today's practice, service professionals, and physicians in particular, have added restraints due to increased government and insurance regulations, liability, working longer hours, less time to spend with patients, all of which result in the practice being less profitable and providing a lower quality of care.

Governmental and insurance rules and regulations include, for instance, electronic payment requirements, HIPAA (Health Insurance Portability and Accountability Act) requirements (such as electronic health transaction standards, unique identifiers, privacy and confidentiality standards, and security and electronic signature standards), coding and audit requirements, restricted formularies, clinical pathways, increased malpractice risks from pseudo standards of care and requirements for more structured data.

However, automated systems have not been well received by the service professional community, with fewer than about 5% of all physicians using some sort of electronic medical record (EMR) system, which is broadly understood to be a medical record system that has the capability to electronically provide all of the functionality and features provided by the paper chart, and data that can be analyzed to develop better care protocols.

Service professionals have resisted those systems since they are unable to keep up with the rapid pace and movement of the service professional during the various tasks which are performed throughout the day.

One disadvantage of those systems is that they are technology-driven, as opposed to being user-driven, and therefore difficult to use, especially by those service professionals that have difficulty with computer technology.

In addition, those systems are fragmented in that they individually implement a single activity of practice management and managed care to manage scheduling, patient registration, insurance information, billing and collections.

The absence of a common technology platform requires multiple custom interfaces to connect the “silos” of information to work together in real-time.

The process of developing interfaces between disparate applications by multiple vendors can be expensive and difficult and is usually costly and labor-intensive to maintain.

Problems are time-consuming and difficult to identify when they arise.

These usually costly and labor intensive interfaces are typically used by larger clinician practice groups (50 or more), integrated delivery networks, and university-based practices.

Consequently, those prior systems do not provide a single system that integrates the features of practice management, patient records and managed care.

Further adding to the problem, those systems are not set up to communicate with each other, so that practices that have more than one system need to enter redundant information into each system.

The various systems are not well suited for interaction between each other, or to maintain information that would be useful to the other systems.

Interfacing also leads to inconsistency in system user interfaces and system versioning is difficult to manage.

Images