METHOD AND SYSTEM OF ENCODING AND PROCESSING ALTERNATIVE HEALTHCARE PROVIDER BILLING

摘要

A system (10) for encoding and encompassing healthcare provider billing, more particularly, a computer assisted network for encoding, documenting and processing claims (18) for payment of specific procedures by alternative therapy providers (12), grouped geographically and by specialty. The system (10) employs a computer accessing three main databases (14, 16, 20) for identifying, encoding and calculating the average cost for provider services (58). A resulting Alternative Billing Code (ABC) is produced which can be compared and correlated with insurance industry standard codes (40). The ABC is an assembly of a series of terms and sub-terms from databases (14, 16, 20), namely Alternative Practice Type (APT) (14), Standard Alternative Procedure Descriptions (SAPDs) (16), Provider Data (PD) (20) and RVU (Relative Value Unit) databases. Each provider specialty includes its own listing of treatments which are turned into RVUs, thus establishing a sequence of treatment fees and charges. The APT code and SAPD code are stored in a PD file including average claim costs of all providers as categorized by a predetermined grouping, which with the PD create the ABC as a comprehensive, single code representing all elements of treatment incident to a patient visit. Claims (18) for payment are submitted and translated into an appropriate code for determination of payment under the present system.