SYSTEM AND METHOD FOR UNIFORMLY PRICING ITEMS

- MedCom Solutions, Inc.

A computer-assisted method for uniformly pricing chargeable items in a healthcare provider's chargeable item database is disclosed. The method applies uniform pricing to identical or related chargeable items. A system for uniformly pricing related chargeable items is also disclosed.

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Description
CROSS REFERENCE TO RELATED APPLICATION

This application claims priority to U.S. Provisional Patent Application No. 60/822,010 filed on Aug. 10, 2006.

BACKGROUND

Computerized methods for reviewing a healthcare provider's chargeable item database are known in the art. However, these methods are often plagued with non-uniform pricing schemes for identical or related chargeable items. Such inconsistent pricing schemes are problematic for the provider in at least three respects. First, pricing errors can affect the provider's ability to collect payment for a claim from Medicare or a private insurer if the price of a submitted claim fails to comply with regulatory requirements. Second, pricing errors or inconsistent pricing is a public relations concern. Finally, the revenue generated by a provider is minimized when chargeable items are priced inconsistently. Implementing and preserving uniform pricing is an arduous task for a healthcare provider.

SUMMARY

In an embodiment, a computer-assisted method for uniformly pricing chargeable items is disclosed. The method comprises the step of accessing a revenue data set for each chargeable item, each revenue data set being stored in at least one storage medium that is compatible with at least one processor and comprising at least one of a gross revenue, a sales volume, and a reference price. Each revenue data set is coded in a form suitable for processing and is capable of being updated. The method further comprises the step of accessing the healthcare provider's chargeable item database, the chargeable item database being stored in one of the at least one storage media and storing a plurality of data entries for each chargeable item. The data entries comprise an identifier that uniquely identifies each chargeable item, a charged price, and a procedural code derived from a coding system that assigns the same procedural code to related chargeable items. The chargeable item database is coded in a form suitable for processing and is capable of being updated. The method further comprises the step of reviewing the charged price for each related chargeable item. The step of reviewing comprises at least one of the following: (i) calculating a final price for each of the related chargeable items, the final price equaling the reference price for the related chargeable item having a preselected parameter, the preselected parameter being derived from the revenue data set; or (ii) excluding from the calculation any of the related chargeable items having an exclusionary code as one of the data entries.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 shows an embodiment of a system.

FIG. 2 is a flowchart illustrating an embodiment of a method for uniformly pricing a chargeable item across departments of a healthcare provider.

 DETAILED DESCRIPTION

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 FIG. 1, which shows an example of a system 10 that comprises at least one processor that uses at least one set of instructions to implement uniform pricing in the chargeable item database 20. The components contained in the computer system of FIG. 1 may be those found in general purpose computer systems and the illustrated components are intended to represent a broad category of such computer components.

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 FIG. 1. In another example each revenue data set 30 is stored as a data entry in the chargeable item database 20. Optionally, the revenue data set 30 is a utilization file created by or for the healthcare provider that is uploaded to one of the computer-readable storage media 40, 45 or to the chargeable item database 20. In an example, the revenue data set 30 is collected at regular time intervals, such as daily, weekly, monthly, quarterly, or annually. The revenue data set 30 for each chargeable item comprises the gross revenue earned by the healthcare provider from sales of the chargeable item, the number of units of the chargeable item sold, or the price charged by the healthcare provider for the chargeable item. In an example, the revenue data set 30 further comprises a predicted price that is the result of either a future price or a budgeted price change.

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 FIG. 1. The processor uses instructions to create the duplicate database 25, which is stored on one of the storage media 40, 45 and replaces or overwrites any preceding duplicate database stored therein. Following the review, calculations, and updates, if any, the processor then uses instructions to export the final price from the duplicate database 25 to the chargeable item database 20 to implement the changes by updating the charged price for each of the related chargeable items.

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 FIG. 2. The revenue data set is accessed in step 200 to derive a preselected parameter that is used to calculate the final price for related chargeable items. Then, in step 300, the chargeable item database is accessed. In a next step 400, the chargeable item database is searched for a selected procedural code to identify related chargeable items, such as by identifying multiple chargeable items having the same procedural code. If the selected procedural code is not entered in the chargeable item database more than one time, then no further action is required and no updates to the chargeable item database are required, as in step 500. If the selected procedural code is entered in the chargeable item database more than one time, then in step 600 the related chargeable items are evaluated to determine if any are excluded from calculations. Any excluded related chargeable item is removed from the calculations, as in step 700. In step 800, the final price for each unexcluded related chargeable item is calculated to be the reference price for the related chargeable item having the preselected parameter derived from the revenue data set in step 200. Then, in step 900, the chargeable item database is updated by implementing the charged price to be the final price. Optionally, the disclosed method of uniformly pricing chargeable items further comprises the step of creating the revenue data set, as in step 100. Optionally, the method further comprises the step 1000 of generating a report, as described above. The report may be generated following any of steps 100-900 above. In the example shown in FIG. 2, the report is generated following the step of updating the chargeable item database.

SPECIFIC EXAMPLE

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.

TABLE 1 Item Procedural Exclusionary Charged Reference Sales Gross Identifier Description Code Code Price Price Volume Revenue XX1 Wrist 73100 F $85 $85 110  $9350 x-ray, 2 view, Operating Room XX2 Wrist 73100 F $75 $75  50  $3750 x-ray, 2 view, Emergency Room XX3 Wrist 73100 F $70 $65 205 $13325 x-ray, 2 view, Radiology XX4 Wrist 73100 T $55 $55 275 $15125 x-ray, 2 view, Outpatient Clinic

Example 1

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.

TABLE 2 Item Procedural Exclusionary Charged Reference Gross Final Identifier Description Code Code Price Price Revenue Price XX1 Wrist 73100 F $85 $85  $9350 $65 x-ray, 2 view, Operating Room XX2 Wrist 73100 F $75 $75  $3750 $65 x-ray, 2 view, Emergency Room XX3 Wrist 73100 F $70 $65 $13325 $65 x-ray, 2 view, Radiology XX4 Wrist 73100 T $55 $55 $15125 $55 x-ray, 2 view, Outpatient Clinic

Example 2

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.

TABLE 3 Item Procedural Exclusionary Charged Reference Gross Final Identifier Description Code Code Price Price Revenue Price XX1 Wrist 73100 F $85 $85  $9350 $85 x-ray, 2 view, Operating Room XX2 Wrist 73100 F $75 $75  $3750 $85 x-ray, 2 view, Emergency Room XX3 Wrist 73100 F $70 $65 $13325 $85 x-ray, 2 view, Radiology XX4 Wrist 73100 T $55 $55 $15125 $55 x-ray, 2 view, Outpatient Clinic

Example 3

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.

TABLE 4 Item Procedural Exclusionary Charged Reference Sales Final Identifier Description Code Code Price Price Volume Price XX1 Wrist 73100 F $85 $85 110 $75 x-ray, 2 view, Operating Room XX2 Wrist 73100 F $75 $75  50 $75 x-ray, 2 view, Emergency Room XX3 Wrist 73100 F $70 $65 205 $75 x-ray, 2 view, Radiology XX4 Wrist 73100 T $55 $55 275 $55 x-ray, 2 view, Outpatient Clinic

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.

Appendix A PC Procedural code of interest In Items having PC, where n=1 . . . n CPn Charged price for item n N Number of items having PC, N=n PRn Reference price for item n FP Final Price Vn Sales Volume for item n GP Group assigned where all In's where the PC of all items is the same GRn Gross revenue for item n E T (exclude) or F (don't exclude) P preselected parameter, where P is Pv (volume), Pgr (gross revenue), Prp (reference price) Step One:

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.

Is N>1? (where N is the number of items having PC) 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.

If N>1, then for each item 1 to n, does E=T or E=F? If E=T for any item, then FP for that item=CP. Step Three: STEP THREE allows the user to make a selection to identify the PRESELECTED CRITERION under which the chargeable items that contain identical Procedure Codes will be commonly priced such as the highest volume or lowest price. Step Four:

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:

Example No. 1: Highest Price From In in GP find MAX (PRn), for all In GP, set FP=MAX (PRn) Example No. 2: Lowest Price From In in GP find MIN (PRn) for all In GP, set FP=MIN (PRn) Example No. 3: Highest Gross Revenue From In in GP find MAX (GRn); for all In GP, set FP=MAX (GRn) Example No. 4: Lowest Gross Revenue From In in GP find MIN (GRn); for all In GP, set FP=MIN (GRn) Example No. 5: Highest Volume From In in GP find MAX (Vn); for all In GP, set FP=MAX (Vn) Example No. 6: Lowest Volume

From In in GP find MIN (Vn); for all In GP, set FP=MIN (Vn)

Claims

1. A computer-assisted method for uniformly pricing chargeable items, said method comprising the steps of:

a. accessing a revenue data set for each chargeable item, each said revenue data set comprising at least one of a gross revenue, a sales volume, and a reference price;
b. accessing said healthcare provider's chargeable item database, said chargeable item database storing a plurality of data entries for each said chargeable item, said data entries comprising an identifier that uniquely identifies said chargeable item, a charged price, and a procedural code derived from a coding system that assigns the same procedural code to related chargeable items; and
c. reviewing said charged price for each said related chargeable item, said step of reviewing comprising at least one of the following: i. calculating a final price for each of said related chargeable items, said final price equaling said reference price for said related chargeable item having a preselected parameter, said preselected parameter being derived from said revenue data set; or ii. excluding from said calculation any of said related chargeable items having an exclusionary code as one of said data entries.

2. A method as set forth in claim 1 further comprising the step of calculating a predicted price.

3. A method as set forth in claim 1 wherein said preselected parameter is selected from the group consisting of a highest reference price, a highest gross revenue, a highest sale volume, a lowest reference price, a lowest gross revenue, a lowest sale volume, a mean reference price a mean gross revenue, a mean sale volume, a median reference price, a median gross revenue, a median sale volume, a reference price falling within a percentile, a gross revenue falling within said percentile, and a sale volume falling within said percentile.

4. A method as set forth in claim 1 wherein said preselected parameter is a reference price.

5. A method as set forth in claim 1 wherein said preselected parameter is a gross revenue.

6. A method as set forth in claim 1 wherein said preselected parameter is a sale volume.

7. A method as set forth in claim 1 wherein said reference price is said charged price.

8. A method as set forth in claim 2 wherein said reference price is said predicted price.

9. A method as set forth in claim 1 further comprising a duplicate database, said duplicate database being a duplicate of said chargeable item database, said duplicate database being stored in one of said storage media and capable of being updated.

10. A method as set forth in claim 9 wherein said step of calculating is performed in said duplicate database.

11. A method as set forth in claim 1 further comprising the step of updating said chargeable item database such that said charged price for each of said related chargeable items equals said calculated final price.

12. A method as set forth in claim 10 further comprising the steps of:

a. updating said duplicate chargeable item database such that said charged price for each of said related chargeable items equals said calculated final price; and
b. uploading said updates to said chargeable item database.

13. A method as set forth in claim 1 wherein said chargeable item database is a Chargemaster.

14. A method as set forth in claim 1 wherein said chargeable item database is a product list.

15. A method as set forth in claim 1 wherein said chargeable item database is a Service Master.

16. A method as set forth in claim 1 wherein said procedural code is selected from the group consisting of a Current Procedural Terminology code, a HCFA Common Procedure Coding System code, an International Classification of Disease code, an internal code, and a private insurer's code.

17. A method as set forth in claim 1 wherein said procedural code is a Current Procedural Terminology code.

18. A method as set forth in claim 1 wherein said procedural code is a HCFA Common Procedure Coding System code.

19. A method as set forth in claim 1 wherein said procedural code is an International Classification of Diseases code.

20. A method as set forth in claim 1 further comprising the step of creating said revenue data set.

21. A uniform pricing system for use by a healthcare provider, said system comprising:

a. for each chargeable item in said healthcare provider's chargeable item database, a revenue data set comprising at least one of a gross revenue, a sales volume, and a reference price, said revenue data sets for related chargeable items being used to derive a preselected parameter,
wherein said chargeable item database stores a plurality of data entries for each said chargeable item, said data entries comprising an identifier that uniquely identifies said chargeable item, a charged price for said chargeable item, and a procedural code derived from a coding system that assigns the same procedural code to related chargeable items; and
b. a processor configured to review said charged price for each said related chargeable item, said review comprising at least one of the following: i. calculating a final price for each of said related chargeable items, said final price equaling said reference price for said related chargeable item having said preselected parameter; or ii. excluding from said calculation any of said related chargeable items having an exclusionary code as one of said data entries.

22. A system as set forth in claim 21 said preselected parameter is selected from the group consisting of a highest reference price, a highest gross revenue, a highest sale volume, a lowest reference price, a lowest gross revenue, a lowest sale volume, a mean reference price a mean gross revenue, a mean sale volume, a median reference price, a median gross revenue, a median sale volume, a reference price falling within a percentile, a gross revenue falling within said percentile, and a sale volume falling within said percentile.

23. A system as set forth in claim 21 wherein said preselected parameter is a highest reference price.

24. A system as set forth in claim 21 wherein said preselected parameter is a highest gross revenue.

25. A system as set forth in claim 21 wherein said preselected parameter is a highest sale volume.

26. A system as set forth in claim 21 wherein said reference price is said charged price.

27. A system as set forth in claim 21 wherein said reference price is a predicted price.

28. A system as set forth in claim 21 further comprising a duplicate database, said duplicate database being a duplicate of said chargeable item database, said duplicate database being stored in one of said storage media and capable of being updated.

29. A system as set forth in claim 21 wherein said chargeable item database is a Chargemaster.

30. A system as set forth in claim 21 wherein said chargeable item database is a product list.

31. A system as set forth in claim 21 wherein said chargeable item database is a Service Master.

32. A system as set forth in claim 21 wherein said procedural code is selected from the group consisting of a Current Procedural Terminology code, a HCFA Common Procedure Coding System code, an International Classification of Disease code, an internal code, and a private insurer's code.

33. A system as set forth in claim 21 wherein said procedural code is a Current Procedural Terminology code.

34. A system as set forth in claim 21 wherein said procedural code is a HCFA Common Procedure Coding System code.

35. A system as set forth in claim 21 wherein said procedural code is an International Classification of Diseases code.

36. A system as in claim 21 wherein at least one of said data entries is an exclusionary code that excludes said chargeable item from said calculations.

37. An apparatus for uniformly pricing chargeable items, said apparatus comprising:

a. means for accessing a revenue data set for each chargeable item to derive a preselected parameter, each said revenue data set comprising at least one of a gross revenue, a number of units sold, and a reference price;
b. means for accessing a healthcare provider's chargeable item database, said chargeable item database storing a plurality of data entries for each said chargeable item, said data entries comprising an identifier that uniquely identifies said chargeable item, a charged price, and a procedural code derived from a coding system that assigns the same procedural code to related chargeable items; and
c. means for reviewing said charged price for each said related chargeable item, said means for reviewing comprising at least one of the following: i. means for calculating a final price for each of said related chargeable items, said final price equaling said reference price for said related chargeable item having said preselected parameter; or ii. means for excluding from said calculation any of said related chargeable items having an exclusionary code as one of said data entries.

38. An apparatus as set forth in claim 37 wherein said preselected parameter is at least one of reference price, gross revenue, sale volume, charged price, or a predicted price.

39. An apparatus as set forth in claim 37 wherein said procedural code is at least one of a Current Procedural Terminology code, a HCFA Common Procedure Coding System code, or an International Classification of Diseases code.

40. A computer readable medium having stored therein instructions which, when executed by a processor, cause the processor to:

a. access a chargeable item database that stores a plurality of data entries for a plurality of said chargeable items, said data entries comprising an identifier that uniquely identifies said chargeable item, a charged price, and a procedural code derived from a coding system that assigns the same procedural code to related chargeable items;
b. identify all related chargeable items having a selected procedural code;
c. access a revenue data set for each of said related chargeable items, each said revenue data set comprising at least one of a gross revenue, a sales volume, and a reference price; and
d. review said charged price for each said related chargeable item, said instructions for said review comprising at least one of the following: i. calculating a final price for each of said related chargeable items, said final price equaling said reference price for said related chargeable item having a preselected parameter, said preselected parameter being derived from said revenue data set; or ii. excluding from said calculation any of said related chargeable items having an exclusionary code as one of said data entries.

41. A computer readable medium as set forth in claim 40 wherein said preselected parameter is at least one of reference price, gross revenue, sale volume, charged price, or a predicted price.

42. A computer readable medium as set forth in claim 40 wherein said procedural code is at least one of a Current Procedural Terminology code, a HCFA Common Procedure Coding System code, or an International Classification of Diseases code.

Patent History
Publication number: 20080040231
Type: Application
Filed: Aug 9, 2007
Publication Date: Feb 14, 2008
Applicant: MedCom Solutions, Inc. (Pittsburgh, PA)
Inventors: William A. Hunt (Pittsburgh, PA), Jennifer Menicucci (Pittsburgh, PA)
Application Number: 11/836,248
Classifications
Current U.S. Class: Price Look-up Processing (e.g., Updating) (705/20)
International Classification: G06Q 30/00 (20060101);