COMPUTERIZED SYSTEM AND METHOD FOR CODING MEDICAL RECORDS TO FACILITATE PROVIDER REIMBURSEMENTS
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United States of America Patent
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app pub date -
Feb 19, 2013
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Feb 16, 2012
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Abstract
A computerized system and method that allows healthcare providers to update the medical codes in health benefits provider member records. Healthcare providers access and update “suspect conditions” for member records in the database. The health benefits provider receives claims for services provided to its members as well as associated, supporting medical records and documentation for the claims. When processing claims, the health benefits provider enters and tracks the claim and related medical data in a database and identifies one or more “suspect conditions” by coding the member records with standardized medical codes such as HCC codes. The healthcare provider researches “suspect conditions” by reviewing supporting documentation and data and updates the records by affirming or denying conditions. The affirmed condition data for a member population along with revised encounter submissions may further be used in projecting risk scores to the member population and a level of reimbursement for the healthcare provider.
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