Abstract:
The embodiments disclose a method of automated electronic health record system including automating the collection, recordation, storage and use patient health information and data to create an electronic health record in a secure electronic environment, using one or more automated systems to facilitate the rapid and accurate collection, storage and use of the electronic health record information and data including automated database access security measures and querying the electronic health record information and data using the one or more automated systems to prepare and process patient billing, health insurance billings and collections and cross check the electronic health record information and data with current governmental and agency compliance and other health related processing.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application is based on U.S. Provisional Patent Application Ser. No. 61/582,320 filed: Dec. 31, 2011, entitled “Method Of Automated Patient Electronic Health Record Patient Intake System”, by Edmond DeFrank; U.S. Provisional Patent Application Ser. No. 61/582,343 filed: Dec. 31, 2011, entitled “Method Of Automated Patient Electronic Health Record Patient Insurance Verification System”, by Edmond DeFrank; U.S. Provisional Patent Application Ser. No. 61/582,349 filed: Dec. 31, 2011, entitled “Method Of Automated Patient Electronic Health Record Preauthorization And Appeal Benefit Determination System”, by Edmond DeFrank; U.S. Provisional Patent Application Ser. No. 61/582,355 filed: Dec. 31, 2011, entitled “Method Of Automated Patient Electronic Health Record Billing And Coding System”, by Edmond DeFrank; U.S. Provisional Patent Application Ser. No. 61/582,359 filed: Dec. 31, 2011, entitled “Method Of Automated Patient Electronic Health Record Compliance System”, by Edmond DeFrank; U.S. Provisional Patent Application Ser. No. 61/582,364 filed: Dec. 31, 2011, entitled “Method Of Automated Patient Electronic Health Record Patient Collection System”, by Edmond DeFrank; and; U.S. Provisional Patent Application Ser. No. 61/582,340 filed: Dec. 31, 2011, entitled “Method Of Automated Gathering Of Patient Medical Records”, by Edmond DeFrank. 
     
    
     BACKGROUND 
       [0002]    Current and planned legislative laws require healthcare plans, healthcare providers, doctors, authorized health care clinicians and staff to establish electronic health records for each patient and guard the privacy of the patient information within the electronic health records. These increased legal requirements make more complex the daily tasks associated with managing the vast volumes of information gathered in the course of delivering health care services and the business aspects of providing health care services such as billing. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0003]      FIG. 1  shows a block diagram of an overview of a method of automated electronic health record system of one embodiment. 
           [0004]      FIG. 2  shows a block diagram of an overview flow chart of an automated electronic health record system of one embodiment. 
           [0005]      FIG. 3  shows a block diagram of an overview flow chart of an automated electronic capture of data of one embodiment. 
           [0006]      FIG. 4  shows a block diagram of an overview flow chart of automated database access security measures of one embodiment. 
           [0007]      FIG. 5A  shows a block diagram of an overview flow chart of an automated patient intake system of one embodiment. 
           [0008]      FIG. 5B  shows a block diagram of an overview flow chart of an automated gathering patient medical records of one embodiment. 
           [0009]      FIG. 6  shows a block diagram of an overview flow chart of an automated patient insurance verification system of one embodiment. 
           [0010]      FIG. 7  shows a block diagram of an overview flow chart of an automated preauthorization and appeal benefit determination system of one embodiment. 
           [0011]      FIG. 8  shows a block diagram of an overview flow chart of an automated electronic health billing and coding system of one embodiment. 
           [0012]      FIG. 9  shows a block diagram of an overview flow chart of an automated electronic health billing and coding system of one embodiment. 
           [0013]      FIG. 10  shows a block diagram of an overview flow chart of an automated compliance system of one embodiment. 
           [0014]      FIG. 11  shows a block diagram of an overview flow chart of an automated patient collection system of one embodiment. 
           [0015]      FIG. 12  shows a block diagram of an overview flow chart of an automated billings and collections analysis report generated of one embodiment. 
           [0016]      FIG. 13  shows a block diagram of an overview flow chart of an automated explanation of benefits (EOB) evaluation of one embodiment. 
       
    
    
     DETAILED DESCRIPTION 
       [0017]    In a following description, reference is made to the accompanying drawings, which form a part hereof, and in which is shown by way of illustration a specific example in which the invention may be practiced. It is to be understood that other embodiments may be utilized and structural changes may be made without departing from the scope of the present invention. 
       General Overview: 
       [0018]    It should be noted that the descriptions that follow, for example, in terms of a method of automated electronic health record system is described for illustrative purposes and the underlying system can apply to any number and multiple types of patients, healthcare plans and healthcare information. In one embodiment the method of automated electronic health record system can be configured using digital devices such as programmable computers, scanners, storage memory devices, digital communication devices, software programming and codes. The method of automated electronic health record system can be configured to include information access security measures and monitoring devices and can be configured to include automation controls to activate digital devices automatically for uses such as optical scanning and optical character recognition using the present invention. 
       Overview: 
       [0019]      FIG. 1  shows a block diagram of an overview of a method of an automated electronic health record system of one embodiment.  FIG. 1  shows an automated electronic health record system  100  used to enable a health care provider to manage the vast volume of record keeping, accounting and production of billing and collections including evaluating multiple patient health insurance policies and the demands of current and projected legislative mandate to create a secure, accessible patient electronic health record  140  (EHR). The automated electronic health record system  100  includes an automated patient intake system  110 . The automated patient intake system  110  uses automated electronic capture of data  115  to begin the process of creating the patient electronic health record  140 . The legislative mandates in part have a goal of creating a patient electronic health record  140  that represents a complete health record of one embodiment. 
         [0020]    The automated electronic health record system  100  includes automated gathering of patient medical records  120  using automated electronic capture of data  115  to gather health care records from outside the current healthcare provider to add past health records to an automated patient electronic health record database  135 . The automated patient electronic health record database  135  is used as the central repository of the electronic health record  140  of one embodiment. 
         [0021]    The automated electronic health record system  100  includes an automated patient insurance verification system  130  used to confirm the current coverage, plan enrollment and benefits of a patient insurance plan. The automated electronic health record system  100  includes automated database access security measures  150  to protect the privacy of the patient information and medical records of one embodiment. 
         [0022]    The automated electronic health record system  100  includes revenue cycle management  155  tools to create comprehensive and timely management of the financial aspects of providing health care services. The revenue cycle management  155  tools include an automated preauthorization and appeal benefit determination system  190 , an automated electronic health billing and coding system  160 , an automated compliance system  170  and an automated patient collection system  180  of one embodiment. 
       Detailed Description: 
     Automated Electronic Health Record System: 
       [0023]      FIG. 2  shows a block diagram of an overview flow chart of an automated electronic health record system of one embodiment.  FIG. 2  shows the automated electronic health record system  100  used to acquire patient health information and data  200  and data collection  202  using the automated electronic capture of data  115 . The automated electronic capture of data  115  is used to record and store data  212  in the automated patient electronic health record database  135  to create an electronic health record  140  of one embodiment. 
         [0024]    The automated electronic health record system  100  processes the automated patient electronic health record database  135  using digital devices  270  including programmable computers  272 , software programming and codes  274 , digital communication devices  276 , storage memory devices  278 , scanners  280  and other digital and electronic devices and systems  282 . The digital devices  270  are used to automatically preform verifications  240 , prepare and process patient billing  242  and health insurance billings and collections  244 . The automated electronic health record system  100  processes compliance cross checking  246  and other health related processing  248 . When a request for information is made using a data query  250  the automated database access security measures  150  protects the information in the automated patient electronic health record database  135  and only lets authorized access to the information. The automated electronic health record system  100  includes systems that can be modified using customization  290 . Customization  290  includes for example input formats customized for a particular health care provider operation of one embodiment. 
       Automated Electronic Capture of Data: 
       [0025]      FIG. 3  shows a block diagram of an overview flow chart of an automated electronic capture of data of one embodiment.  FIG. 3  shows uploading of information and data into an electronic health record database  300  using a data I/O device  302  to record the automated electronic capture of data  115 . The automated electronic capture of data  115  uses optical character recognition  306  to convert into digital readable text information and data from for example outside patient authorized data sources  310 . The outside patient authorized data sources  310  can be sending a health care plan  312 , past medical records from a healthcare provider  314 , information from a pricing network  316  and other data sources  318  of one embodiment. 
         [0026]    The information being sent can be in the form of hard copy data  322  and faxed data  324 . The automated electronic capture of data  115  uses automation controls to activate digital devices automatically  326  including for example optical scanning  328  and optical character recognition  306  to convert the information into digital readable text for recordation into the electronic health record database  300 . The outside patient authorized data sources  310  can be sending electronic data  338  wherein the automated electronic capture of data  115  uses automation controls to activate digital devices automatically  326  for example optical character recognition  306  to process the electronic data  338  of one embodiment. 
       Automated Database Access Security Measures: 
       [0027]      FIG. 4  shows a block diagram of an overview flow chart of automated database access security measures of one embodiment.  FIG. 4  shows the automated database access security measures  150  used to create multi-character codes to provide storage of vast amounts of data files  402 . A data I/O device  302  used for example in the automated electronic capture of data  115  routes the data through the automated database access security measures  150  which performs automated coding of patient information  412  for recordation in the electronic health record database  300 . 
         [0028]    When an outside unauthorized data I/O device  418  tries to perform a data query  250  the automated database access security measures  150  uses a limited authorized access to electronic health record database coded descriptions of patient information  422  features to check whether the data query  250  is from an authorized user. The outside unauthorized data I/O device  418  is not authorized and the system responds that database access is denied  424  and no data is transferred. 
         [0029]    When an internal authorized data I/O device  428  or outside authorized data I/O device  430  performs the data query  250  the limited authorized access to electronic health record database coded descriptions of patient information  422  features confirms they are authorized. The automated database access security measures  150  performs automated monitoring of database access and data transfers  436 . The automated database access security measures  150  include frequent automated encrypted password changes  438  using information access security measures and monitoring devices  426 . If the user enters an incorrect password  440  database access is denied  424 . If the user enters the correct password  446  database access is approved  448  and the data I/O device  302  routes the data query  250  to the electronic health record database  300 . The electronic health record database  300  transmits the coded data in patient records  454  to the requesting internal authorized data I/O device  428  or outside authorized data I/O device  430  of one embodiment. 
       Automated Patient Intake System: 
       [0030]      FIG. 5A  shows a block diagram of an overview flow chart of an automated patient intake system of one embodiment.  FIG. 5A  shows the automated patient intake system  110  processing patient personal information  502  for example a scan and electronic copy of insurance card  504 . This information is used to get in-network with all 3rd party pricers  506  using the automated electronic capture of data  115 . The patient personal information  502  includes a patient electronic signature  514  to authorize access by the health provider to the information and an automated assignment of benefits  516  from a patient health plan provider  518  of one embodiment. 
         [0031]    The patient electronic signature  514  is used to create an automated plan request form  524  which is automatically sent to the patient health plan provider  518 . The automated patient intake system  110  includes an automated plan tutorial for verbal request follow-up  528  for health provider staff use. When a health insurance plan is received  530  health insurance plan benefits data  532  is processed using the automated electronic capture of data  115  and recorded in the electronic health record database  300 . The health insurance plan benefits data  532  is processed including automated network 3rd party pricers benefit payments  540 , automated patient copayments determination  542  and automated lien and assessment of benefits  544  and coded using the automated database access security measures  150 . Other patient intake processing is described in  FIG. 5B  of one embodiment. 
       Automated Gathering Patient Medical Records: 
       [0032]      FIG. 5B  shows a block diagram of an overview flow chart of an automated gathering patient medical records of one embodiment.  FIG. 5B  shows the automated gathering patient medical records  120  using client intake  550  processing patient personal information  502 . The patient personal information  502  is used in a enrollment system  554  including website enrollment  556 , doctor&#39;s office enrollment  558  and other locations and means to enroll  560 . The automated gathering patient medical records  120  includes generating automatically a signature form  562  with the patient electronic signature  514 . The signature form  562  is used to create a client authorization and power of attorney for release of medical records  566  that will accompany an automated medical records request form  568  of one embodiment. 
         [0033]    The automated medical records request form  568  is used to request patient medical records including all EOB, prescriptions, treatment, surgery, x-rays and other information  570 . If the automated medical records request form  568  when not received in a timely fashion the automated gathering patient medical records  120  generates an automated records requests follow-up  572 . When the automated medical records request form  568  is responded to the information received is processed using the automated electronic capture of data  115 . The information received is entered into the electronic health record database  300  to create or append electronic health record  578  of one embodiment. 
       Automated Patient Insurance Verification System: 
       [0034]      FIG. 6  shows a block diagram of an overview flow chart of an automated patient insurance verification system of one embodiment.  FIG. 6  shows the automated patient insurance verification system  130  includes electronic  602  and verbal  616  capture of insurance benefits. The electronic  602  capture of co-insurance benefits  604  including patient deductible  606 , patient co-pay  608  and patient out of pocket maximum  610 . The electronic  602  capture and verbal  616  capture of benefits information is entered into the electronic health record database  300  of  FIG. 3 . The benefits information entered includes benefits/exclusions/page numbers  618 , durable medical equipment (DME)  620 , maximum per day  622 , in-patient &amp; outpatient services  624  and 3rd party pricers: Multiplan, Viart, Beech, First Health, and others  626 . The electronic  602  and verbal  616  captures of insurance benefits includes co-payments  632  of the patient. The automated patient insurance verification system  130  includes recording of a reference # verifying the benefits and a reminder to get reference # 630  when the information is captured using a verbal  616  inquiry of one embodiment. 
       Automated Preauthorization and Appeal Benefit Determination System: 
       [0035]      FIG. 7  shows a block diagram of an overview flow chart of an automated preauthorization and appeal benefit determination system of one embodiment.  FIG. 7  shows the automated preauthorization and appeal benefit determination system  190  is used to automatically assess a determined expected payment amount  702  using the captured benefits information for a patient treatment or procedure. The automated preauthorization and appeal benefit determination system  190  processes an automated preauthorization  704  using an automated preauthorization request to health plan provider  706 . The automated preauthorization and appeal benefit determination system  190  records the benefits/exclusions/page numbers/compliant coding  708  and insurance plan allowed amount  710 . The automated preauthorization and appeal benefit determination system  190  proceeds to record preauthorization ref. # &amp; amount authorized  712  of one embodiment. 
         [0036]    When a health plan provider pays an incorrect amount  716  the automated preauthorization and appeal benefit determination system  190  processes an automated benefit payment appeal  718 . The automated benefit payment appeal  718  is used to automatically include billing support information  720  and a preauthorization ref. # 722 . The billing support information can include clearinghouse UCR  724  as a Usual, Customary and Reasonable payment, 3rd party pricers  726  payment amounts, correct co-insurance and patient paid amounts  728 . The automated benefit payment appeal  718  may result in a benefits appeal payment approved  730  and additional appeal payment received  732  of one embodiment. 
         [0037]    The automated benefit payment appeal  718  may result in a benefits appeal payment denied  736 . If denied the automated preauthorization and appeal benefit determination system  190  uses an automated legal action module  738  to process a legal action. The automated legal action module  738  is used to track legal action  740 . When a legal action generates award  742  the automated legal action module  738  processes a legal action award collections  744  protocol. The automated benefit payment appeal  718  may result in a legal action rejected  750  which ends the appeals process of one embodiment. 
       Automated Electronic Health Billing and Coding System: 
       [0038]      FIG. 8  shows a block diagram of an overview flow chart of an automated electronic health billing and coding system of one embodiment.  FIG. 8  shows the automated electronic health billing and coding system  160  used to prepare billing for patient treatment or procedures orders automatically entered into the EHR  802 . The automated electronic health billing and coding system  160  automatically gathers necessary information to be sent in support of the billing  804 . Treatment or procedure coding  806  is automatically confirmed using the automated compliance system  170 . The automated electronic health billing and coding system  160  is used wherein insurance coverage and benefits automatically researched and entered into the EHR  812  are used to determine the insurance plan allowed amount  710 . Included in the billing are the co-insurance benefits  604 , patient deductible  606  and has deductible been met  820 , the patient co-pay  608  and patient out of pocket maximum  610  and has patient out of pocket maximum been reached  826 . The automated electronic health billing and coding system  160  uses the automated preauthorization and appeal benefit determination system  190  to determine 3rd party pricing (UCR)  828  and proceeds to automatically prepare billings  832 . The automatic preparation of billings is further described in  FIG. 9  of one embodiment. 
       Automatically Prepared Billings: 
       [0039]      FIG. 9  shows a block diagram of an overview flow chart of an automated electronic health billing and coding system of one embodiment.  FIG. 9  shows the automated electronic health billing and coding system  160  processes used to automatically prepare billings  832 . The automated electronic health billing and coding system  160  processes payment requests automatically generated and transmitted to the health plan provider  904 . The processes to automatically prepare billings  832  include any co-payments by the patient are billed automatically to the patient  906 . 
         [0040]    The automated electronic health billing and coding system  160  includes processes wherein an automatic billings and collections analysis report generated  908  and distributed to responsible staff members  912 . The processes to automatically prepare billings  832  include a late payment reminder automatically sent to the payor  916  wherein a late payment alert automatically sent to staff member responsible  918  of one embodiment. 
         [0041]    The automated electronic health billing and coding system  160  includes an automated explanation of benefits (EOB) evaluation  922  showing an insurance plan allowed amount received  924  including a process to analyze vs. expected payment amount received  926 . If an incorrect payment received  930  it is automatically reported to the automated preauthorization and appeal benefit determination system  190  of one embodiment. 
       Automated Compliance System: 
       [0042]      FIG. 10  shows a block diagram of an overview flow chart of an automated compliance system of one embodiment.  FIG. 10  shows the automated compliance system  170  including ICD-10 coding  1004  and other applicable coding standards  1002  which are automatically entered and updated to database  1006 . The automated compliance system  170  references the automated patient insurance verification system  130  insurance plan benefits/exclusions/page numbers  1010  which are automatically cross referenced  1012  with the respective codes. A cross referenced diagnosis code determined  1016  is entered onto patient treatment or procedures orders  1014 . The patient treatment or procedures orders  1014  include a cross referenced treatment or procedure coding determined  1020 . The automated compliance system  170  automatically corrects non-compliant coding  1018 . The automated compliance system  170  is used wherein compliant cross referenced codes entered in EHR and on patient treatment or procedures orders  1024  of one embodiment. 
       Automated Patient Collection System: 
       [0043]      FIG. 11  shows a block diagram of an overview flow chart of an automated patient collection system of one embodiment.  FIG. 11  shows the automated patient collection system  180  wherein accounts receivable A/R information  1104  is entered using the automated electronic capture of data  115 . The A/R information  1104  is recorded in the electronic health record database  300 . The automated patient collection system  180  includes using automated calls  1110  and automated letters  1112  in the collection efforts. An automated patient copayments determination  542  is processed to collect those amounts from the patient. If a patient keeps any amounts related to the automated assignment of benefits  516  the automated patient collection system  180  automatically processes lawsuits against patients for keeping money  1118 . The automated patient collection system  180  processes automatic assemblage of supporting documentation  1120  for use in lawsuits by patients against insurance/employer plan/complaints  1122  of one embodiment. 
       Automatic Billings and Collections Analysis Report Generated: 
       [0044]      FIG. 12  shows a block diagram of an overview flow chart of an automatic billings and collections analysis report generated of one embodiment.  FIG. 12  shows the automatic billings and collections analysis report generated  908  including accounts receivable (A/R) aging report  1202 . The automatic billings and collections analysis report generated  908  includes a process used to rank collections efforts by activity success rate  1204  and evaluate for discounted A/R purchase advisability  1206 . The automatic billings and collections analysis report generated  908  is used to compare collections to UCR  1212 , analyze patient treatment or procedures orders  1214  for frequency  1216 , costs of supplies  1218  and cost of equipment usage  1220  of one embodiment. 
         [0045]    The automatic billings and collections analysis report generated  908  is used to analyze actual cost to UCR  1224 , evaluate current supplies and equipment procurement  1226 , recommend in-house billing amount changes  1228  and analyze and recommend other sourcing to reduce cost  1230 . The automatic billings and collections analysis report generated  908  are used to compare collections to UCR  1212  for an out of network provider  1236  and evaluate for advisability of contracting with network  1238 . The evaluation of contracting with a network includes processes to analyze various networks for payments and cost to rank possible candidate networks  1240  and recommend  1242  actions to maintain status quo  1244  or explore contracting further  1246  of one embodiment. 
       Automated Explanation of Benefits (EOB) Evaluation: 
       [0046]      FIG. 13  shows a block diagram of an overview flow chart of an automated explanation of benefits (EOB) evaluation of one embodiment.  FIG. 13  shows the automated explanation of benefits (EOB) evaluation  922  is used to evaluate the insurance plan allowed amount received  924  and analyze vs. expected payment amount received  926 . The automated explanation of benefits (EOB) evaluation  922  is used to determine a correct amount  1306  or incorrect amount  716  received. The evaluation incorporates the use of an update co-insurance benefits  1308 , an update patient deductible paid  1310 , the amount of patient co-pay  608  and an update patient out of pocket payments  1314 . If the amount received is the correct amount  1306  a process is used to mark billing paid in full  1316 . If the amount received is an incorrect amount  716  the collection is automatically referred to the automated preauthorization and appeal benefit determination system  190  of one embodiment. 
         [0047]    The foregoing has described the principles, embodiments and modes of operation. However, the invention should not be construed as being limited to the particular embodiments discussed. The above described embodiments should be regarded as illustrative rather than restrictive, and it should be appreciated that variations may be made in those embodiments by workers skilled in the art without departing from the scope as defined by the following claims.