Patent ID: 8103522

Claim:
A server for calculating a reimbursement amount for a health care claim, comprising: a computer processor and associated memory; an input module encoded on a computer-readable medium assessable by said computer processor for enabling said computer processor to receive medical claim data from a hospital; a database stored on said memory containing hospital cost benchmarking data; a benchmarking module encoded on the computer readable medium configured to calculate the hospital cost benchmarking data by grouping inpatient medical claims into one or more benchmark groups based on a refined diagnosis related group assignment and a severity classification assignment, wherein the one or more benchmark groups classify the inpatient medical claims into classifications of severity based on co-morbidities and complications and their impact on resource use; and wherein the inpatient medical claims are further grouped into similar hospital groups wherein similar hospitals are hospitals having similar attribute data including having bed capacities that match a user selected range for the number of beds in the hospital, having a matching classification as a teaching or non-teaching hospital, and having a matched urban or rural location; and said computer processor capable of calculating the reimbursement amount for the received medical claim, wherein a methodology module is encoded on the computer-readable medium and enables said computer processor to apply a pre-selected calculation methodology in calculating the reimbursement amount based upon the received medical claim data and hospital cost benchmarking data; the pre-selected calculation methodology including: 1) comparing an inpatient medical claim to the one or more benchmark groups having the same diagnosis related group assignment and severity classification assignment and 2) grouping outpatient medical claims into ambulatory patient classification assignments; and 3) calculating the reimbursement amount for the received medical claim based on the comparison, and an output module is encoded on the computer-readable medium and enables said processor to provide the reimbursement amount and hospital cost benchmarking data to the hospital.