System and method for calculating claim reimbursement recommendations
US8103522B1 · kind B1 · utility
3Cited by
3References
30Claims
0Family size
Assignee
Inventors
Key dates
| Filing date | Jun 27, 2008 |
| Grant date | Jan 24, 2012 |
| Priority date | — |
| Expiry date | Oct 17, 2029 |
Classification
- Technology area (CPC G)Physics
- CPC primaryG16H70/20
- WIPO fieldIT methods for management
- WIPO sectorElectrical engineering
Abstract
The present invention provides a system and method for calculating claim reimbursement recommendations. A medical claim is received and grouped to an rDRG or a median cost value. All similar hospital cases based on the same rDRG are identified. Costs of all comparison cases are then adjusted based on hospital's wage index. Using a pre-selected methodology, the initial target reimbursement amount is calculated. Any applicable override rules and/or inflation factors are then applied to arrive at the reimbursement amount. All relevant information on reimbursement amount and how the amount was calculated is presented to the user.
Source: USPTO / EPO open patent data. Objective bibliographic and citation counts.