Abstract: An automated system is disclosed for managing accounts receivable for outstanding healthcare accounts. In particular, the system in accordance with the present invention is an automated system which preemptively assesses the risk of denials of outstanding healthcare accounts by way of a self-learning engine driven by current data and prioritizes those accounts for follow up according to the risk profile of the account. As such, the system is able to minimize denials by the respective payers thereby improving optimizing the efforts of healthcare accounts receivable personnel while improving the revenue yield and minimizing the revenue cycle.

Abstract: A patient financial advocacy system is disclosed for identifying potential funding sources for uninsured patients and for the patient portion of healthcare debts that are covered by managed healthcare plans by automating the identification of potential funding sources and automating the collection of data required by such potential funding sources. The system is an automated system ad includes three stages, namely, a detection stage; an execution stage and a measurement stage. In the detection stage, a multi-tiered questionnaire is used during a patient interview to identify potential funding sources. In accordance with an important aspect of the invention, the questionnaire is structured to find the funding source with the highest yield. A rules engine is programmed to analyze the patient's answers to the questions and identify a potential funding source.

Abstract: A system is disclosed that is useful by hospitals and other healthcare providers for automatically determining the best possible or maximum amount of payments a healthcare provider can lawfully expect to receive for healthcare resources which takes into account various discounts agreed upon by the healthcare provider with various private insurance companies as well as public (i.e., government) insurance providers, which administer managed healthcare plans including Medicare and Medicaid, all payments received against expected payments and a yield measurement approach for determining the providers performance at a given point in time and across various segments of its operations. In accordance with one aspect of the present invention, contracts between a healthcare provider and all private insurance companies and public insurance providers may be modeled.