All medical facilities regardless of size and areas of expertise, prepare, send, receive, and submit medical insurance claim. The process in the last several years has grown so complicated with changing laws and regulations that, to efficiently manage a medical practice or establishment, it’s necessary to computerize records and the process of billing.
Nearly all hospitals doctors, hospitals, and other medical facilities that are equipped with electronic patient records have the software, via the company that provided their software and hardware, an Electronics Claims Submissionsystem. This permits them to submit medical claims to various insurance companies , such as Medicare or Blue Cross Blue Shield. You can submit insurance claims through sending them via phone using a modem, or by putting the claim on a magnetic tape, and then mailing it or sending it to an insurance provider. This is the most commonly used ways of submitting claims to insurance.
No matter how the claim was made after the claim has been accepted by the insurance company the company prints the claim determination and then sends it back to a medical provider. At this point,it is then necessary for the provider’s staff to manually enter into their records the decision made on the form returned to claim and rely on their knowledge of claim interpretation and how their particular medical system processes claims. This process is lengthy expensive and costly and is prone to human errors.
The only exception to this method of return is the transmission of the claim determination via a telephone line data link or tape-to-tape transfer. These options can be quite expensive and require specialized software. They aren’t affordable by the majority of hospitals, clinics and practices.
There are two options that can automate the process of posting insurance claims. They are accessible to a limited amount of medical offices scattered across different states. In the first method, the insurance company will post its assessment of the claim directly to the service’s medical system over the telephone line via the modem. The medical institution must have complete faith that the insurer will reimburse the right amount and send the correct amount. They should also surrender all control of their medical system, and take away all security measures from their medical system in order to be able to accept the insurance provider. The medical institution or medical office mustalso be running only the medical software program that the insurance company’s software can communicate with. This isn’t possible because of these limitations.
Another method is when the insurance company transfers its decision onto a magnetic tape that can be directly loaded into the provider’s health system. This method is difficult since it is not able to control data entry, lacks security, and requires that the medical program be used by the institution or medical office. Also, it is an expensive cost.
In addition, as these are the only available ways to any medical office or institutions for an electronic claims receipt A large portion of them utilize the method of manual entry on keyboards.
A lot of medical offices, hospitals and clinics have a computer network that connects to various terminals. These hospitals, medical offices and clinics already have and utilize a range of software systems to manage the patient’s records, billing and accounting. Because of their existing to their assets and the training they receive in their medical software and hardware they are largely unable to accept systems like those mentioned by Pritchard (U.S. Pat. No. 4,491,725) and Barber (U.S. Pat. No. No. They will not accept systems that demand that they eliminate all their hardware and software systems previously purchased and in use.
A lot of clinics, hospitals and medical offices have computers in their medical systems that records patient information, processes claims, maintains the records of patients and tracks financial accounting for business. Processing insurance claims is one of the most complicated and challenging tasks. There are currently hundreds of such medical systems in use and available. While each system performs the same features, they differ in hardware and software implementations. It is, therefore, difficult, and even impossible often, to transfer data from one medical system to the other. It is generally impossible to add an additional function for an existing medical system unless it was specifically written by the manufacturer of the particular medical system.
Since the most complex task involves the process of processing insurance claims, a lot of these manufacturers of medical systems have come up with and offered customers an option to electronically transmit, through phone lines, insurance claims to the two major claim-handling companies, namely Medicare and Blue Cross Blue Shield. You can make a claim to any of the other hundreds of insurance companies by printing it out and transmitting it to the correct insurance company. This add-on package doesn’t allow electronic receipt from the medical center in relation to the process of processing the claim by the insurance provider. The medical center is still able to receive the processed claim via mail in paper form. The claim is then sent manually.
The current invention is designed to create an automated system to submit medical insurance claims. It is cost-effective, doesn’t compromise the security of any medical computer system, and works with all insurance carriers’ computers, and is extremely efficient and precise.
It is another objective of the invention to create a system to automate the submission of medical insurance claims. The system relies on the use of scanner and optical character recognition technology combined with software based on the present invention that automatically detects and corrects scanner and OCR imperfections and irregularities and checks for suspicious configurations and posts the received, scanned, and transformed claims directly to the medical computer system viaits entry screens.
Another objective of the present invention to create a system for the automated posting of medical insurance claims that reduces the manual entry of the submitted insurance claims into the provider’s medical system. The complexity involved in the entry of claims processed into the provider’s medical system is time-consuming, leads to errors, and generally calls for a full time person to manage the process on their own. In the end, not only is the expense of delay reduced but also the accuracy and speed of claim posting processing are greatly increased.
Another object of the invention is to automate the posting process of any document printed or created by machines to any system on the internet. This will reduce the time and accuracy associated manual posting.
The following description will assist you to comprehend the other aspects of the invention.Click here to view the patent on USPTO website.
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What is a software medical device?
The FDA may refer to software functions that include ” Software As a Medical Device” and “Software in Medical Device(SiMD)”, which are software functions that are integral to (embedded in a) medical device.
Section 201(h) of the Federal Food, Drug, and Cosmetic Act, ?21 U.S.C. 321(h),(1) defines the term “medical device” as apparatus, instrument, machine, contrivances, implant an in vitro regulator or other similar or related items and a component or accessory. . . (b) is intended for diagnosis or treatment of disease or other conditions in humans or animals. (c) Is intended to alter the structure or functions of the human body or animal. To be considered a medical device, and therefore subject to FDA regulations the software must satisfy at least one of the following conditions:
- It should be intended to aid to diagnose or treat patients; or
- It must not be designed to change the structure or function of the body.
If your program is intended to be utilized by healthcare professionals to diagnose treat, or manage the patient’s information in hospitals or other healthcare facilities, the FDA will likely consider such software as medical devices subject to regulatory review.
Is Your Software a Medical Device?