Invented by W. Thomas Green, III, James T. Ingram, Johnathan Samples, Gregory H. Schulenburg, Greenway Health Inc
The Greenway Health Inc invention works as follows
The disclosure is an integrated medical software with location-driven billing coding. The system consists of an information component which automatically retrieves payment data, demographic data, and location data of a healthcare provider. A clinical component captures at a minimum one diagnosis code, one procedure code, or one evaluation and management code when a clinician or staff member of the healthcare provider enters clinical data into an electronic document.
Background for Integrated Medical Software System with Location-driven Bill Coding
Service professionals who regularly schedule patient appointments have relied on manual practice management, patient record and managed care (i.e. insurance) techniques for many years. Paper calendars and file folders are used to schedule patients, track prescription orders and maintain file documentation. A patient’s appointment is scheduled by an office assistant on a paper calendar. The service professional checks the paper calendar for each day.
For the purposes of this application service professionals can include healthcare providers like physicians (MD, DO), chiropractors, psychologists and counselors. The terms “clinician” and “physician” are not the same. or ?physician? “Any service professional or healthcare provider that treats a patient is included in the term used herein, such as physicians, nurses and technicians, therapists chiropractors, midwives, psychologists and counselors.
All information pertaining to the patient’s history has been traditionally kept in a paper file. This includes clinician observations, thoughts and treatments, patient history, medication, vaccination lists, charts, progress reports, hospital reports, correspondence, test results, etc. This information is often handwritten by clinicians and signed, or it may be transcribed directly from clinician dictation. The patient’s name and date of birth are usually listed alphabetically in the paper-based medical file.
However manual practice management techniques, patient records and managed care are inefficient, since they require an enormous amount of interaction between the office assistant and the service professional. Service professionals often lose time due to last-minute scheduling changes. Manual tracking can be error-prone and generates a lot of paper, which takes up valuable office space. “A small office with 2-3 doctors, for example, could have 20,000 active patients or more, and 25,000 to 60,000 files depending on how long the physicians have been practicing.
Because the medical records are paper-based, and produced manually, the information required to bill a customer must be manually input into the billing software.” The handwritten orders of clinicians that are often the basis for billingable procedures can be difficult to process. They are also frequently omitted on patient bills. Handwritten prescription orders have also been identified as a leading cause of medical mistakes that result in death for patients in the United States. “Add to these issues, the complexity of the insurance contracts and fee schedules which govern the amount that clinicians will be paid for their service, and you have a labor-intensive, inefficient process.
In a typical medical clinic visit, the clinician reviews his/her daily or weekly schedule. The clinician can have up to two (or more) procedures and 20-80 visits in a single day. The office assistant will retrieve the file from central files and hand it to the clinician before the scheduled appointment. This allows the clinician to review the relevant medical history of the patient as well as determine the purpose for the visit.
A typical patient visit takes 10 minutes. The physical examination lasts 2-5 minutes. The clinician may make notes on the patient’s condition after the examination or even during it. They will also order necessary tests, provide prescriptions and tell the patient if a follow-up appointment is needed. The clinician will spend 2-5 minutes making progress notes, and placing them in the file of the patient.
If tests are conducted on-site, either the laboratory technician, or the nurse, performs the test. The clinician may wait until the results are available before releasing a patient. They can then review the results together with the patient. Some tests may be performed off-site and then reported to the clinician. After the first office visit, the test results should be analyzed, reported to the patient and possible follow-up appointments scheduled.
The amount of paperwork that is required can have a major impact on a service professional. This often reduces the time they spend with patients. Every hour spent in the emergency department requires one hour of paperwork. Every hour of patient care in surgery and acute care inpatients results in 36 minutes worth of paperwork. Every hour of patient care in skilled nursing care results 30 minutes of paperwork. In home health care, each hour of patient care is accompanied by 48 minutes of paper work. “A physician can spend between 22 and 38% of their time charting.
In today’s practice, physicians and service professionals have been restrained by increased government and insurer regulations, liability, longer working hours and less time with patients. This has led to a practice that is less profitable and provides a lower level of care. The rules and regulations of the government and insurance companies include electronic payment requirements, HIPAA requirements (such electronic health transactions standards, unique identifiers and privacy and confidentiality standards), coding and auditor requirements, restricted formularies and clinical pathways, as well as increased malpractice risk from pseudo standards.
There is therefore a need for an efficient system to reduce the time a clinician spends on tasks outside of the practice of medicine such as paperwork and dictation. It is also necessary to have a system which can reduce the time that other employees in the clinic spend, such as the office assistants, the nurses, the assistant clinician, and the laboratory technicians. These systems should also comply with insurance and government regulations, and provide data which can be analyzed in order to develop better protocols.
Patent No. US Pat. Nos. 5,991,730, 5,991,729, 5,946,659, 5,933,809, and 5,899,998 to Lubin et al., Barry et al., Lancelot et al., Hunt et al. and McGauley et al., respectively. The service professions have been slow to adopt automated systems. Fewer than 5% of physicians use an electronic medical record (EMR), which can provide all the features and functionality of a paper chart and allow data to be analyzed in order to create better care protocols.
Service professionals have been resistant to those systems because they cannot keep up with their rapid pace and movements throughout the day. These systems are technology-driven and not user-driven. They can be difficult to use by service professionals who have trouble with computer technology.
In addition, these systems are fragmented, in that each implements a single activity, such as practice management or managed care, to manage scheduling, registration of patients, insurance information and billing and collection. When physicians use EMR, managed care, and practice management applications to manage their practices the applications are usually standalone and run on different technology platforms.
The lack of a common platform for technology requires the creation of multiple interfaces that connect’silos’. Information to be able to interact in real time. It can be difficult and expensive to develop interfaces that connect disparate applications from multiple vendors. They are also usually labor-intensive and costly to maintain. The time it takes to diagnose problems is long and can be difficult. These interfaces, which are usually labor-intensive and expensive, are used by large clinician practice groups (50+), integrated delivery networks and university-based practices.
These systems are not able to provide a system that integrates features such as practice management, patient record and managed care. These systems do not communicate well with one another, which means that practices who have more than a single system will need to enter duplicate information in each system. “The various systems are not designed for interactivity between them or to maintain useful information to other systems.
However even if these fragmented system could communicate with each other, the systems were merely interfaced and not integrated. Interfaced systems exchange limited data in order to meet practice management, EMR, and managed care requirements. Interfacing systems require multi-vendor assistance and the sharing limited data between limited system components, multiple databases and limited system components. “Interfacing leads to inconsistent user interfaces, and it is difficult to manage system versions.
It is therefore an object of this invention to provide medical software that integrates with the EMR all aspects of managed care and practice management, such as scheduling, patient registration, billing, insurance, and collections. Another object of the invention is to provide a secure practice management system with functionality and usability that tracks service professionals’ work flow and maximizes manual resources. Another object of the invention is to provide a cost-effective practice management system, which can be implemented and maintained by small groups of clinicians (2-5), while being configurable to suit the needs of different specialties.
The system integrates a central framework module, a scheduling module, registrant component, account management module, and clinical modules to provide a seamless exchange of information. The system integrates the central framework module with a registration module, an account module, a clinical module and a scheduling component to ensure a seamless information exchange.
The clinical module has an administration builder which allows users to create a template that is customized. Templates are used to create documents such as H&P Notes and progress notes, which are stored in the electronic chart of a patient. The progress note template helps the clinician record a patient’s encounter. It provides predefined sections and sentences which can be easily filled out by the clinician either during or after the encounter. The generated templates and documents are designed to look like a paper chart. To avoid clinicians entering redundant data, information gathered from patient scheduling, registration and triage as well as previous encounters is used to pre-populate templates. These documents are used to generate charges automatically, and then electronic requests are sent electronically to a claims clearinghouse.
The system results in increased revenue due to coding accuracy, billing and fee schedule cross referencing to reduce under-payments and over-payments, writeoffs, improved clinician productivity, improved claims management and payment reconciliation of under payments, patient care reminders that generate preventive/preventative care visits, and improved receivables collections. The system reduces costs such as the cost to copy and store documents and records, malpractice premiums, transcription fees, paper and supplies, rejected claims, costs associated with claims processing, and labor savings.
