Billing System Test Result Counting Accuracy
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Solution Overview
Problem
Existing billing systems for sample analyzers lack accuracy in identifying and charging for reportable sample test results, often including non-reportable measurements such as quality control samples, errors, and duplicates, leading to inaccurate billing.
Innovation Solution
A method and system that utilize adaptable determination rules to selectively include or exclude test results based on customer-specific criteria, ensuring only reportable test results are counted for billing purposes.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Measurement precision
If existing billing systems charge uniformly for all sample measurements performed by the sample analyzer, then the billing process is simple and fast, but the billing accuracy deteriorates because non-reportable measurements (quality control samples, errors, duplicates) are incorrectly included
Solution Approach 1:
The billing system segments test results into reportable and non-reportable categories by applying multiple determination rules. Each rule evaluates specific conditions (quality control samples, errors, duplicates, patient vs. non-patient samples) to classify test results, enabling accurate billing while maintaining system manageability through modular rule-based evaluation
Solution Approach 2:
The system performs preliminary classification of test results before billing by evaluating determination rules in advance. The analyzer or billing system pre-identifies reportable test results and excludes non-reportable ones (quality control, errors, duplicates) before generating billing data, ensuring accuracy without adding complex real-time billing logic
2Reliability
If the billing system includes all sample measurements without judgment, then the billing process is straightforward, but the reliability deteriorates as the system cannot accurately specify which measurements should be billed
Solution Approach 1:
The billing system incorporates feedback mechanisms where determination rules evaluate test result characteristics and provide feedback on reportability. The system continuously refines billing decisions by checking against multiple criteria (error flags, sample type, duplication status) and adjusts billing inclusion based on this feedback loop, ensuring reliable and consistent billing outcomes
Solution Approach 2:
The determination rules act as intermediaries between the raw test data and the billing process. These rules evaluate test results and determine reportability without requiring complex billing logic to directly analyze each measurement, serving as a mediator that simplifies the overall system while improving reliability through structured evaluation
3Measurement precision
If adaptable determination rules are implemented for each customer to select reportable test results, then billing accuracy improves by excluding non-reportable measurements, but the system complexity increases due to customizable rules for different customers
Solution Approach 1:
The billing system implements dynamic adaptability where determination rules can be customized for different customers based on their specific needs and contractual agreements. The system allows flexible configuration of which rules apply to which customers, enabling precise control over reportable test result identification while maintaining a standardized core framework that manages complexity
Data Source
AI summary
Methods and systems are disclosed for generating accurate reportable test result counts for client billing purposes. In one approach, a method includes receiving, via network, a plurality of test results from at least one sample analyzer of each of a plurality of customers, selecting test results from the plurality of test results based on a plurality of determination rules adaptable to each of the customers, and determining, for each of the customers, a number of the selected test results for billings to each of the customers. Systems capable of performing the above method and other methods are likewise disclosed.