Researchers Submit Patent Application, “Questionnaire Based Medical Billing Platform Automating ICD-10 Codes with integration of proper CPT coding”, for Approval (USPTO 20240194315): Patent Application

Health Policy and Law Daily

2024 JUL 01 (NewsRx) -- By a News Reporter-Staff News Editor at Health Policy and Law Daily -- From Washington, D.C., NewsRx journalists report that a patent application by the inventor Poovey, John P. (Grand Junction, CO, US), filed on December 7, 2023, was made available online on June 13, 2024.

No assignee for this patent application has been made.

News editors obtained the following quote from the background information supplied by the inventors: “

“Field of the Invention

“The present invention which relates to medical billing platforms automating ICD Codes with integration of proper CPT coding.

“Background

“Getting sick can be costly. That’s why most people have acquired medical insurance or health insurance, including Medicare and Medicaid, for themselves and their families. With health insurance, people (theoretically) obtain a cheaper and more convenient way to get their ailments treated.

“Medicare is a government national health insurance program in the United States, begun in 1965 under the Social Security Administration and now administered by the Centers for Medicare and Medicaid Services. It, primarily, provides health insurance for Americans aged 65 and older, but also for some younger people with disability status as determined by the Social Security Administration. Medicaid in the United States is a federal and state program that helps with healthcare costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and personal care services. The main difference between the two programs is that Medicaid covers healthcare costs for people with low incomes while Medicare provides health coverage for the elderly. There are also dual health plans for people who have both Medicaid and Medicare. The Health Insurance Association of America describes Medicaid as “a government insurance program for persons of all ages whose income and resources are insufficient to pay for health care.”

“As of 2020 it had been estimated that over 91% of the U.S. population is covered by private or public health insurance. According to United States Census Borough, in 2022 over 92% of people, or 304.0 million, had health insurance at some point during the year. Thus, not only are the patients and the doctors involved in the treatment and the diagnosis and treatment of a medical problem, but so too are the medical insurers.

“In order to hasten the payment process, to document the diagnosis and treatment, and to make everyone understand the medical problem, coding systems have been developed. There are three major coding systems used by medical billers and insurers: the Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) and Healthcare Common Procedure Coding System (HCPCS level II).

“Coding Systems

“The American Medical Association (AMA) was actually the first to tackle the problem before HCPCS coding. In efforts to standardize reporting of medical, surgical, and diagnostic services and procedures, the association created a coding system and introduced CPT in 1966. The CPT codes (also referenced as HCPCS level 1) were and are developed by the AMA and generally are for reporting medical procedures and services such as diagnostic, laboratory, radiology, and surgical. The CPT codes describe what was done to the patient during the consultation. The procedure code listed by the practitioner generally is found by the medical provider in “the CPT book” or now via an online listing. The selected code is intended to describe the medical services and procedures done by the medical professional. It aims at providing a uniform language to describe the treatment and diagnostic procedures performed and aid in the communication between doctors, patients, and insurance companies. Most commercial payers, based on the plan design, require one or more CPT codes in any claim.

“Even at this time, the government had already become a major payer of healthcare services. While it too needed to standardize healthcare claims, it also bore the responsibility of controlling costs for taxpayers. With this dual agenda, it created the HCFA Common Procedure Coding System (HCPCS). The history of HCPCS coding began in 1978 when the federal government created this coding system to attempt standardize the reporting of medical services to the federal government for reimbursement. The HCPCS system, however, underwent several changes before adoption by commercial payers, which action was eventually mandated by the Health Insurance Portability and Accountability Act (HIPAA) in 1996. Prior to the advent of procedure coding, providers submitted written descriptions of the services they performed to payers for reimbursement. This proved inefficient, in that 100 providers could report the same service with 100 different descriptions.

“Standardization in medical reporting was not achieved by the development of initial coding systems as in the subsequent decade, more than 120 different coding systems came into play, causing widespread variations in payers’ guidelines and claim forms. However in 1983, the HCFA Common Procedure Coding System (HCPCS) was merged with AMA’s CPT system and use of the CPT system was mandated for all Medicare billing. Currently, HCPCS level 1 is the CPT system.

“The two organizations collaborated on the development of a new code set to report medical-related expenses not represented in the CPT codes, items such as orthotic and prosthetic procedures, hearing and vision services, ambulance services, medical and surgical supplies, drugs, nutrition therapy, durable medical equipment, outpatient hospital care, and Medicaid. The resulting code set, also implemented in 1983, begins where the CPT coding ends. As such, it is the second of two principal subsystems of HCPCS, aptly named HCPCS Level II. Through the evolution of HCPCS coding, the CPT coding is incorporated as the backbone of Level I, and the newer HCPCS Level II is now known as a procedure coding system.”

As a supplement to the background information on this patent application, NewsRx correspondents also obtained the inventor’s summary information for this patent application: “In summary, the questionnaire based billing platform of the present invention allows a medical practitioner, such as a dentist, to quickly generate appropriate diagnostic codes (e.g. ICD-10 codes) and collate them and allow them to obtain proper CPT codes based upon the ICD codes. In other words, the medical billing platform of the present invention facilitates medical billing for procedures deemed within the medical scope of the practice and generating billing with appropriate ICD and CPT codes that are CMS approved and audit proof. The questionnaire based billing platform creates an autofill note that may be customized by the individual medical practitioner or user for their general practice while generating essentially pre-approved final billing.

“In one embodiment of the present invention a questionnaire based billing platform and associated methodology includes inputting a patient health history into the platform; generating automatically by the platform a list of one or more ICD codes based upon the patient health history; generating automatically by the platform a listing of CPT codes associated with the list of one or more ICD codes; selecting on the platform by a medical practitioner one or more CPT codes to be performed on the patient from the listing of CPT codes associated with the list of one or more ICD codes; generating an on-line user fillable operative notes template based upon the selected CPT codes, wherein the selected CPT codes are matched with ICD codes; prompting the practitioner to fill out all relevant portions of the on-line user fillable operative notes template; obtaining a signature of the practitioner on the on-line user fillable operative notes template following the practitioner filling out all relevant portions of the on-line user fillable operative notes template, wherein the practitioner is prevented from providing a signature to complete the form until all relevant portions of the on-line user fillable operative notes template have been properly filled out; and generating a bill by the platform based upon the completed and signed on-line user fillable operative notes template.

“In one embodiment of the present invention an on-line questionnaire based billing platform includes an online patient health history input form for each patient on the platform; an automatically generated listing of one or more ICD codes based upon each patient health history; an automatically generated listing of CPT codes associated with the list of one or more ICD codes; select CPT codes to be performed on the patient which are selected by the medical practitioner from the listing of CPT codes associated with the list of one or more ICD codes; an on-line user fillable operative notes template generated by the platform based upon the selected CPT codes, wherein the selected CPT codes are matched with ICD codes; wherein the system is configured to prompt the medical practitioner to fill out all relevant portions of the on-line user fillable operative notes template; wherein the system is configured to obtain a signature of the medical practitioner on the on-line user fillable operative notes template following the practitioner filling out all relevant portions of the on-line user fillable operative notes template, wherein the medical practitioner is prevented from providing a signature to complete the on-line user fillable operative notes template until all relevant portions of the on-line user fillable operative notes template have been properly filled out; and a bill generated by the platform based upon the completed and signed on-line user fillable operative notes template.

“Currently a medical practitioner would conduct a health history of a patient then proceed separately to look up codes that would be appropriate (via manually, on-line or various systems or even combinations of such methods) while the questionnaire based billing platform of the present invention effectively allows the health history intake to automatically generate the relevant ICD codes. The generated listing of ICD will then generate associated CPT codes which can be selected by the practitioner and once the practitioner selects the desired CPT codes (that are matched with the relevant ICD codes) which are being performed, an operative notes template will be generated that will allow the practitioner to fill in the relevant portions with the operative notes template including prompts for all required part. Following the filling of the template there is a signature requirement to complete the process. The practitioner, or their billing department, then can user completed signed notes to generate a bill that is audit proof to be paid by the insurer.

“Additionally the questionnaire based billing platform of the invention allows for easy pre-approval of the patient which itself can allow the patient to make informed medical decisions based upon known coverage. The questionnaire based billing platform of the invention generates approved billing thus facilitates the third party creation of EOB (explanation of benefits), and the platform provides that such an EOB can be uploaded by practitioner for improved accounting (allowing tracking and proper accounting of differences between billable, allowable and reimbursable amounts for a given patient)

“As noted, the questionnaire based billing platform of the invention more easily generates and formats bills to be audit proof and to be timely paid by insurers. Additionally in the constantly changing billing environment the platform of the invention avoids having everyone go through denial due to insurance or other regulatory agency changes. Systemic changes may be made in real time to update billing due to changes.”

The claims supplied by the inventors are:

“1. A questionnaire based billing platform methodology comprising the steps of: i) Inputting a patient health history into the platform; ii) Generating automatically by the platform a list of one or more ICD codes based upon the patient health history; iii) Generating automatically by the platform a listing of CPT codes associated with the list of one or more ICD codes; iv) Selecting on the platform by a medical practitioner one or more CPT codes to be performed on the patient from the listing of CPT codes associated with the list of one or more ICD codes; v) Generating an on-line user fillable operative notes template based upon the selected CPT codes, wherein the selected CPT codes are matched with ICD codes; vi) Prompting the medical practitioner to fill out all relevant portions of the on-line user fillable operative notes template; vii) Obtaining a signature of the medical practitioner on the on-line user fillable operative notes template following the practitioner filling out all relevant portions of the on-line user fillable operative notes template, wherein the medical practitioner is prevented from providing a signature to complete the on-line user fillable operative notes template until all relevant portions of the on-line user fillable operative notes template have been properly filled out; and viii) Generating a bill by the platform based upon the completed and signed on-line user fillable operative notes template.

“2. The questionnaire based billing platform methodology according to claim 1, wherein the inputting a patient health history into the platform is via an on-line consult questionnaire input form having a series of yes or no questions.

“3. The questionnaire based billing platform methodology according to claim 2, wherein the on-line consult questionnaire is in a common procedural language for procedures deemed within the medical scope of the practice of medical practitioner.

“4. The questionnaire based billing platform methodology according to claim 1, wherein the platform limits selectable CPT codes to procedures deemed within the medical scope of the practice of medical practitioner.

“5. The questionnaire based billing platform methodology according to claim 1, the completed and signed on-line user fillable operative notes template forms a signed record of i) procedures performed upon the patient, ii) findings of medical note discovered during the procedures, iii) occurrences of medical note during the medical procedure, and iv) post-procedure instructions for the patient from the medical practitioner.

“6. The questionnaire based billing platform methodology according to claim 1, further including the step of submitting pre-authorizations to payers wherein the pre-authorizations to payers is based upon the selected CPT codes, wherein the selected CPT codes are matched with ICD codes.

“7. The questionnaire based billing platform methodology according to claim 1, further including the step of obtaining a signature or biometrics from the patient on a pre-procedure description within the platform prior performing procedures on the patient.

“8. The questionnaire based billing platform methodology according to claim 1, further including the step of uploading an Explanation of Benefits into the platform for the patient wherein the Explanation of Benefits is payer’s written explanation regarding a claim or authorization showing at least what the payer paid or will pay and what the patient paid or will pay.

“9. The questionnaire based billing platform methodology according to claim 1, wherein the on-line user fillable operative notes template based upon the selected CPT codes further includes any necessary Healthcare Common Procedure Coding System codes associated with the procedures.

“10. The questionnaire based billing platform methodology according to claim 1, wherein the platform utilizes AI to generate the questionnaires and templates of the platform based upon input from medical practitioners, acceptance of claims by payers and rejections of claims by payers.

“11. The questionnaire based billing platform methodology according to claim 1, wherein the platform automatically updates changes to ICD codes or CPT codes and the associations between these codes.

“12. An on-line questionnaire based billing platform comprising: i) An online patient health history input form for each patient on the platform; ii) An automatically generated listing of one or more ICD codes based upon each patient health history; iii) An automatically generated listing of CPT codes associated with the list of one or more ICD codes; iv) Select CPT codes to be performed on the patient which are selected by the medical practitioner from the listing of CPT codes associated with the list of one or more ICD codes; v) An on-line user fillable operative notes template generated by the platform based upon the selected CPT codes, wherein the selected CPT codes are matched with ICD codes; vi) Wherein the system is configured to prompt the medical practitioner to fill out all relevant portions of the on-line user fillable operative notes template; vii) Wherein the system is configured to obtain a signature of the medical practitioner on the on-line user fillable operative notes template following the practitioner filling out all relevant portions of the on-line user fillable operative notes template, wherein the medical practitioner is prevented from providing a signature to complete the on-line user fillable operative notes template until all relevant portions of the on-line user fillable operative notes template have been properly filled out; and viii) a bill generated by the platform based upon the completed and signed on-line user fillable operative notes template.

“13. The questionnaire based billing platform according to claim 12, the patient health history input form is in a common procedural language for procedures deemed within the medical scope of the practice of medical practitioner.

“14. The questionnaire based billing platform according to claim 12, wherein the platform limits selectable CPT codes to procedures deemed within the medical scope of the practice of medical practitioner.

“15. The questionnaire based billing platform according to claim 12, wherein the completed and signed on-line user fillable operative notes template forms a signed record of i) procedures performed upon the patient, ii) findings of medical note discovered during the procedures, iii) occurrences of medical note during the medical procedure, and iv) post-procedure instructions for the patient from the medical practitioner.

“16. The questionnaire based billing platform according to claim 1, further including pre-authorizations to payers generated by the platform.

“17. The questionnaire based billing platform according to claim 16, wherein the pre-authorizations to payers is based upon the selected CPT codes, wherein the selected CPT codes are matched with ICD codes.

“18. The questionnaire based billing platform according to claim 12, further including the Explanation of Benefits uploaded into the platform for the patient wherein the Explanation of Benefits is payer’s written explanation regarding a claim or authorization showing at least what the payer paid or will pay and what the patient paid or will pay.

“19. The questionnaire based billing platform according to claim 12, wherein the on-line user fillable operative notes template based upon the selected CPT codes further includes any necessary Healthcare Common Procedure Coding System codes associated with the procedures.

“20. The questionnaire based billing platform according to claim 1, wherein the platform utilizes AI to generate the questionnaires and templates of the platform based upon input from medical practitioners, acceptance of claims by payers and rejections of claims by payers.”

For additional information on this patent application, see: Poovey, John P. Questionnaire Based Medical Billing Platform Automating ICD-10 Codes with integration of proper CPT coding. U.S. Patent Application Number 20240194315, filed December 7, 2023 and posted June 13, 2024. Patent URL (for desktop use only): https://ppubs.uspto.gov/pubwebapp/external.html?q=(20240194315)&db=US-PGPUB&type=ids

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