In an embodiment, a system 10 of uniformly pricing chargeable items provided by a healthcare provider is disclosed. In an example, the system 10 is embodied in a computer system such as the one shown in
As described in more detail below, embodiments of the system 10 review the prices charged for related chargeable items and calculate a uniform final price for related chargeable items using a predetermined parameter, the predetermined parameter being selection criteria to uniformly price related chargeable items based on data stored in a revenue data set 30 (described below). In an example, the predetermined parameter requires that the final price for each related chargeable item equal the reference price for the related chargeable item having the highest sales volume, the highest gross revenue, or the highest reference price. Likewise, the system 10 may be used to review and optionally update the prices charged by different departments within the healthcare provider for the same chargeable item so that the chargeable item is uniformly priced between each of the healthcare provider's departments.
Chargeable items are, for example, chargeable supplies and services provided by or on behalf of the healthcare provider. In examples, chargeable items are technical chargeable items such as healthcare provider charges for services and supplies or professional chargeable items such as physician service charges. Data entries for each chargeable item are stored in a chargeable item database 20 that is capable of being updated. In an example, the chargeable item database 20 is the healthcare provider's Chargemaster, which is a comprehensive and healthcare provider-specific listing of each item that could be billed to a patient. In another example, the chargeable item database 20 is the healthcare provider's Service Master, which is a comprehensive and healthcare provider-specific listing of each professional service that could be billed to a patient. In another example, the chargeable item database 20 is the healthcare provider's product list. The chargeable item database 20 may be stored on a computer-readable storage medium 40 and is coded in a form suitable for processing. Data entries include, for example, an identifier that uniquely identifies each chargeable item and the price charged for the chargeable item. Other examples of data entries for each chargeable item include the name of or designation indicating the department within the healthcare provider that provides the chargeable item or a description of the chargeable item. Optionally, an alpha or numeric procedural code is also assigned to at least one of the chargeable items. Procedural codes are derived from a coding system that assigns the same procedural code to related chargeable items. In an example, the coding system is an internal coding system that is created by or for the healthcare provider. In another example, the coding system is a published system used within the healthcare industry, such as the Current Procedural Terminology (CPT®) codes that are used to designate procedures or services provided by a physician,1,2 the HCFA Common Procedure Coding System (HCPCS) codes published by Medicare that are used to designate particular supplies or services provided by a healthcare provider, or the International Classification of Diseases codes published by the World Health Organization. In another example, the coding system is derived from published codes developed by private insurance carriers or HMOs. An example of data entries for four related chargeable items is shown in Table 1. 1CPT® is a registered trademark of the American Medical Association.2Current Procedural Terminology is a copyright 2005 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained therein. Applicable FARS/DFARS restrictions apply to government use.
Optionally, one of the data entries for at least one of the related chargeable items is an exclusionary code that flags that chargeable item to be excluded from calculations, updates, and/or uniform pricing. In an example, an item having an exclusionary code is designated by the code “True” or “T” and an item not having an exclusionary code is designated by the code “False” or “F.” Reasons for exclusion include but are not limited to: (1) the charged price is manually set by the healthcare provider; (2) there is no sales volume or gross revenue data for the chargeable item; and (3) the healthcare provider has designated that the charged price for the chargeable item be maintained at its current print.
The chargeable item database 20 is capable of being updated. Updates include changes to the data entries for chargeable items, including price. Updates are made either manually or by a processor that uses a set of computer-coded instructions stored in a computer-readable storage medium 40, 45 to implement the update.
For each chargeable item, there is a corresponding revenue data set 30 that tracks sales volume, gross revenue, and pricing for each chargeable item listed in the chargeable item database. The revenue data set 30 is capable of being updated. In an example, the revenue data set 30 for each chargeable item is stored in a database that is stored on a computer-readable storage medium and coded in a form suitable for processing. In an example, the storage medium is the storage medium 40 on which the chargeable item database 20 is stored. In another example, the storage medium is a second storage medium 45, as shown in
If the system 10 is implemented in software, the storage medium 40, 45 stores the executable code when in operation. The main memory may include banks of dynamic random access memory as well as high-speed capable memory. Where the system 10 is a computer system, the processor may contain a single microprocessor, or may contain a plurality of microprocessors for configuring the computer as a multi-processor system. The processor uses the instructions to process the review, such as by converting a request for a review to a readable format, including those that are computer-readable, readable by a user of the system consultant, or a combination thereof. In an example, a parser program imports the review request into the processor and the processor uses instructions to convert the review request into a readable format.
The processor uses instructions to identify related chargeable items in the chargeable item database 20 by searching for multiple entries of the same procedural code. If multiple entries of the same procedural code are identified, then the processor uses instructions to review the price of the related chargeable items. In an example, the review comprises calculating the final price for the related chargeable items, where the final price is uniform for all chargeable items with the same procedural code and optionally updating the charged price for each related chargeable item in the chargeable item database 20 to reflect the calculation (described below). Predetermined parameters derived from revenue data sets 30 corresponding to each chargeable item are used by the processor to select the final price of related chargeable items. In another example, the final price of at least one of the chargeable items is not updated to be uniform with the other related chargeable items, such as when an item is excluded from updates by an exclusionary code, as described above. As described in more detail below, examples of preselected parameters may include the highest or the lowest gross revenue, sales volume, price, etc.
Optionally, the processor uses instructions to generate a report that summarizes the result of the review and reports any calculated final prices or any updates made to the chargeable item database 20. The results of the review request or the search request may be displayed in a format that can be exported to a software-based file such as a Microsoft Excel® file.
Optionally, the system further comprises a duplicate database 25 that is a duplicate of the chargeable item database 20 and that is used to perform the review and update of the chargeable item database 20, as shown in
In order to display textual and graphical information, the system contains the graphics subsystem and the output display (not shown). In an example, the readable formats are displayed on an output display. The output display may include a cathode ray tube display or a liquid crystal display. The graphics subsystem receives textual and graphical information and processes the converted requested update and corresponding data entry from the duplicate database 25 for display on the output display. A graphical user interface (GUI) designed to collect certain information regarding data entries or chargeable items can be used to facilitate entry of the requested update and the corresponding data entry.
The system 10 may further include a mass storage device, peripheral devices, portable storage medium drives, input control devices, a graphics subsystem, and an output display (not shown). The computer system may be connected through one or more data transport means, such as a network 50. For example, the processor and the main memory may be connected via a local microprocessor bus, and the mass storage device, peripheral devices, portable storage medium drives, and graphics subsystem may be connected via one or more input/output (I/O) busses. The mass storage device, which may be implemented with a magnetic disk drive or an optical disk drive, is non-volatile storage device for storing data and instructions for use by the processor. In the software embodiment, the mass storage device stores the information software for loading to the main memory.
The system 10 optionally comprises an input device for inputting the requested review. The input device has an input control device that provides a portion of the user interface for a user of the system and an input display. Examples of the input control device are an alpha numeric keypad for inputting alpha numeric and other information, or a cursor control device such as a mouse, a trackball, a stylus, or cursor direction keys. In order to display textual and graphic information, the computer system contains the graphics subsystem and the input display. Examples of the input display include a cathode ray tube display or a liquid crystal display. The graphics subsystem receives textual and graphical information and processes the submitted input for display on the input display. A graphical user interface (GUI) that is designed to collect certain information regarding chargeable items can be used to facilitate entry or input. The input device is optionally a software or web-based application that enables the authorized user to submit input, including the review request or a search request to search the duplicate database 25.
In another embodiment, a computer-assisted method of uniformly pricing items is disclosed. An example of the method of uniform pricing is shown in
Table 1 provides the data entries for four chargeable items having item identifiers XX1, XX2, XX3, and XX4 and the corresponding revenue data set for each. Related chargeable items XX1-XX4 have the same procedural code 73100. Item XX4 is designated with an exclusionary code “T,” to exclude Item XX4 from all calculations. Therefore, any price updates to related chargeable items having procedural code 73100 will not be implemented for Item XX4 and the charged price will remain $55.
Table 1 also provides the revenue data set for each chargeable item XX1-XX4. In the examples below, the predetermined parameter is derived from these data sets to calculate the final price to update the price charged for each unexcluded related chargeable item XX1-XX3. The examples below illustrate the use of a variety of predetermined parameters for the calculations.
In this example, the instructions instruct that the final price of the related chargeable items equals the reference price of the related chargeable item having the highest gross revenue. The instructions will utilize the equation set forth in Appendix A attached hereto to compare the gross revenue of each of items XX1-XX3. Then, the final price will be calculated to equal the reference price of the chargeable item having the highest gross revenue. In this example, the gross revenue of Item XX3, $13325, is greater than the gross revenue of either Item XX1 or XX2. Therefore, the final price for Items XX1-XX3 is calculated by the instructions to equal the reference price of Item XX3, $65. This is depicted in Table 2, below. As described above, the final price for Item XX4 is not updated because of the exclusionary code.
In this example, the instructions instruct that the final price of the related chargeable items equal the reference price of the related chargeable item having the highest reference price. The instructions will utilize the equation set forth in Appendix A attached hereto to compare the reference of each of items XX1-XX3. Then, the final price will be calculated to equal the reference price of the chargeable item having the highest reference price. In this example, the reference price of Item XX1, $85, is greater than the reference price of either Item XX2 or XX3. Therefore, the final price for Items XX1-XX3 is calculated by the instructions to equal the reference price of Item XX1, $85. This is depicted in Table 3, below. As described price for Item XX4 is not updated because of the exclusionary code.
In this example, the instructions instruct that the final price of the related chargeable items equal the reference price of the related chargeable item having the lowest sales volume. The instructions will utilize the equation set forth in Appendix A attached hereto to compare the sales of each of items XX1-XX3. Then, the final price will be calculated to equal the reference price of the chargeable item having the lowest sales volume. In this example, the sales volume of Item XX2, 50, is less than the sales volume of either Item XX1 or XX3. Therefore, the final price for Items XX1-XX3 is calculated by the instructions to equal the reference price of Item XX2, $75. This is depicted in Table 4, below. As described above, the final price for Item XX4 is not updated because of the exclusionary code.
Various embodiments of the present invention may be implemented on computer-readable media. The terms “computer-readable medium” and “computer-readable media” in the plural as used herein may include, for example, magnetic and optical memory devices such as diskettes, compact discs of both read-only and writeable varieties, optical disk drives, hard disk drives, etc. A computer-readable medium may also include memory storage that can be physical, virtual, permanent, temporary, semi-permanent and/or semi-temporary. A computer-readable medium may further include one or more data signals transmitted on one or more carrier waves.
While embodiments of the invention have been shown and described with particularity in connection with the accompanying drawings, the invention may be otherwise embodied within the scope of the following claims.
The first step is to identify within the Revenue Data Set all occurrences whereas there are multiple instances of chargeable items that contain identical Procedure Codes. If there are any instances of multiple Procedure Codes, the method then goes to STEP TWO.
STEP TWO goes to the Revenue Data Set to determine if any of the chargeable items with identical procedure codes have an Exclusionary Flag. Excluded is a characteristic assigned in the chargeable item database and is denoted by a “True” or “T” designation in the chargeable item database. If a chargeable item is not excluded, it is denoted by a “False” or “F” designation in the chargeable item database. If an item is excluded, it is denoted by a “True” or “T” designation. Any excluded item is excluded from further analysis and calculation and FP=CP.
STEP FOUR is where the calculation takes place to determine what price will be used to commonly price all non-excluded chargeable items as follows:
From In in GP find MIN (Vn); for all In GP, set FP=MIN (Vn)
This application claims priority to U.S. Provisional Patent Application No. 60/822,010 filed on Aug. 10, 2006.
Number | Date | Country | |
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60822010 | Aug 2006 | US |