System for management and documentation of health care decisions

Abstract

The problem with healthcare today is that clinicians are required to make time sensitive decisions without a complete, comprehensive, objective and easily accessed picture of a patient's overall condition. Healthcare data lives in multiple, unconnected silos and paper based files. The result to hospitals is lost revenue, administrative inefficiencies and increased labor costs. The tool as described above solves for these challenges by providing real time, accumulated, analyzed and scored data and corresponding and relevant workflows that can be accessed at the point of care through claim payment and finalization.

Description

[0001]This application claims the benefit of U.S. Provisional Patent Application Ser. No. 62 / 058,121 filed Oct. 1, 2014, which is incorporated by reference herein in its entirety.[0002]The field of invention is a platform that provides institutional healthcare providers a single, integrated solution that connects prospective clinical decision making and post claim denial resolution. This invention integrates disparate sources of discrete and non-discrete clinical, financial and administrative health care data and provides technology and analytics that enable institutional healthcare entities to make accurate, data driven care level decisions, provides workflow to ensure care decisions are made timely, manages hand-offs across care givers necessary for patient throughput and captures rationale behind care level decisions for use in post payment denials resolution.DESCRIPTION OF RELATED ART[0003]Healthcare providers lose billions of dollars annually due to unreimbursed or under-reimbu...

AI Technical Summary

Benefits of technology

[0009]It has recently been discovered that the challenges as described above can be solved through the deployment of a tool that consolidates discrete and non-discrete administrative, financial and clinical data real-time into a single system, that applies real time analytics that guides clinical decisions, that applies known and customizable denial and audit targets through a dynamic rules engine and provides a workflow infrastructure that connects front end decision making with back-end denials management, documentation, and audit defense.

Problems solved by technology

Healthcare providers lose billions of dollars annually due to unreimbursed or under-reimbursed services.

Most lack access to objective clinical and financial data and analytics necessary to proactively ensure reimbursement accuracy and retrospectively resolve payment issues.

Providers also lack the ability to accurately document the decisions they make.

The result is a loss of revenue and increased administrative expense for healthcare providers.

Additionally, functional areas that have an impact on ensuring appropriate revenue are disjointed, existing platforms are administratively burdensome and provide only “point in time” optics.

Should a claim be deemed non-compliant for these reasons (and others), the hospital is at risk for non-payment and / or a take-back of payment and a resulting loss of revenue after the services were provided.

In many cases, take-backs can date back as far as 3 years and affect hospital revenue and reserves.

In order to reclaim payment, hospitals must go through a rigorous, largely manual and time consuming appeals process that can take up to 5 years.

Generally, hospitals are challenged in both regards.

Today, due to lack of integrated, timely and comprehensive data, these decisions are inconsistent, disjointed and somewhat subjective.

Unfortunately, due to lack of credentialed staff, widely dispersed data and poor internal system infrastructure, these review processes are generally costly, ineffective and still effectively manual.

Nor does the ability to recreate automated clinical determinations.

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