Patent ID: 7801744
Filing Date: 2010-09-21
Classification: G06Q,G16H

Abstract:
1. One or more tangible computer-storage media having computer-useable instructions embodied thereon for performing a method for adjudicating and reimbursing a care provider for services provided for a clinical event, the method comprising: receiving a transaction including a number of clinical event details for the clinical event; determining an initial level of reimbursement using the number of clinical event details for the clinical event; accessing a first knowledge base comprising a number of criteria for assessing quality of health care provided for the clinical event; selecting at least one appropriate criterion based on the clinical event details; wherein the criteria comprises mortality, morbidity, length of visit or stay in a healthcare facility, onset of another condition due to poor care, recurrence, elimination of presenting problem, quality of life indicators, patient satisfaction and unplanned visits due to poor care; performing analysis of the clinical event details against the selected at least one criterion to determine the quality of health care; determining, via a computing device, a quality adjustment for use in adjusting the initial level of reimbursement in accordance with the quality of health care provided for the clinical event using the clinical event details electronically documented by the care provider at a point of care for the clinical event for which reimbursement is sought; and determining an adjusted level of reimbursement by applying the quality adjustment to the initial level of reimbursement to attain the adjusted level of reimbursement.