Abstract: The present invention relates generally to healthcare, and more specifically to a process for more completely and more accurately identifying and collecting health insurance plan members' medical diagnoses in compliance with the regulations of one or more health insurance payors such as, but not limited to, the United States Centers for Medicare and Medicaid Services' (“CMS”) Medicare Advantage regulations. In particular, the present invention provides a computer interface whereby health insurance companies may ensure that their members are accurately diagnosed and that claims are accurately filed by reviewing existing member medical records to identify additional diagnoses which may have been treated but not specifically identified in claims filed by the members' health care provider.

Abstract: The present invention relates generally to healthcare, and more specifically to a process for more completely and more accurately reporting a patient diagnosis under the Diagnosis-Related Group (“DRG”) system promulgated by the United States Centers for Medicare and Medicaid Services (“CMS”). In particular, the invention relates to a method for reviewing hospital discharge charts; identifying diagnosis codes which may be inaccurate or inadequately documented; gathering a set of clinical guidelines related to the medical conditions represented by such inaccurately or inadequately documented diagnosis codes; and presenting the identified codes with the gathered clinical guidelines to a treating healthcare provider for the provider's review and possible alteration.

Abstract: The present invention relates generally to healthcare, and more specifically to a process for more completely and more accurately identifying and collecting health insurance plan members' medical diagnoses in compliance with the regulations of one or more health insurance payors such as, but not limited to, the United States Centers for Medicare and Medicaid Services' (“CMS”) Medicare Advantage regulations. In particular, the present invention provides a system, method, or computer program product whereby health insurance companies may ensure that their members are accurately diagnosed and that claims are accurately filed by reviewing existing member medical records to identify additional diagnoses which may have been treated but not specifically identified in claims filed by the members' health care provider.

Abstract: The present invention relates generally to healthcare, and more specifically to a process for more completely and more accurately diagnosing the health condition of health insurance plan members through a comprehensive health assessment. In doing so, the method of the present invention reflects the guidelines established by various insurance payors such as the United States Centers for Medicare and Medicaid Services (“CMS”). The present invention further provides a method for monitoring follow-up member care to increase the likelihood that the quality of medical care given to plan members is increased.