Abstract: The expected charges for treating a patient are estimated by the use of linear regression techniques wherein variables and coefficients of estimate models are built from historic patient data of all episode types (inpatient, office visits, etc.) and which include secondary and collateral illnesses that greatly affect the cost of treating a patient for the primary illness. In addition to evaluating the primary illness, the evaluation of collateral illness is also made possible since the processing techniques are not simply averaging data for the primary illness as has been done in the past. This allows physicians to understand the magnitude and types of resource usage that are appropriate for particular illnesses. The present invention allows better management of many aspects of the healthcare system by significantly reducing a component of the difference between the estimate and actual charges for treating a particular illness of a patient that is due to the general state of health of the patient.

Abstract: The likely consumption of health provider resources that are necessary to treat a particular medical patient are estimated within the framework of the existing Federal mandated system that uses Diagnostic Related Groups (DRG's) for setting the amount of payment that a hospital or other health provider will receive from the United States Government for that patient under the Medicare reimbursement system. The amount of payment is made from a calculation using the DRG system, regardless of the actual cost to the health provider. The Federal system results in a wide variation of health care costs occurring within each DRG, resulting from varying degrees of overall sickness among patients that are similarly classified. The present invention works within the DRG system and all of the sub-groups of DRG's including groups of diagnosis codes and individual diagnosis codes.

Abstract: A computer system for identifying the most appropriate of the billing categories (Diagnosis Related Groups) prescribed by the a governmental entity as a basis for determining the amount that health care providers, such as hospitals, are to be reimbursed under Medicare and similar programs for services provided to patients. The computer system responds to an initial determination of a category, upon admission of a patient, to list for medical personnel involved in giving care to the patient, such as the attending physician, a few other medically related categories for consideration as diagnosis and treatment proceeds. Only those related categories that can apply to a particular patient are listed for that patient, thereby reducing the time necessary for the physician to review and designate any new category that may be more accurate than the first.