Performance of an enterprise computer system

Abstract

A computer system and method for performing analytics on electronic data containing information regarding inpatient population to identify one or more inpatient records that were coded and/or reimbursed incorrectly so as to generate an electronic report indicating a return-on-investment (ROI) scenario when coding is corrected. Utilized are one or more of MS-DRG codes and code sets, payer, length of stay, and ICD codes to determine a preliminary list of inpatient records coded and reimbursed incorrectly. A visual user based report is generated that indicates a return-on-investment scenario if the electronic data containing information regarding inpatient population is corrected and rebilled based on user prescribed criteria.

What is claimed is: 
     
         1 . A computer method for performing analytics on electronic data containing information regarding inpatient population to identify one or more inpatient records that were coded and/or reimbursed incorrectly so as to generate an electronic report indicating a return-on-investment (ROI) scenario when coding is corrected, comprising:
 utilizing one or more of MS-DRG codes and code sets, payer, length of stay, and ICD codes, to determine a preliminary list of inpatient records coded and reimbursed incorrectly; and   providing a visual user based report indicating a return-on-investment scenario if the electronic data containing information regarding inpatient population is corrected and rebilled based on user prescribed criteria.   
     
     
         2 . The method of  claim 1 , further including analyzing one or more of accounts receivables data, cash collections data, staff and account productivity data, revenue charge capture data and denials data to identify one or more data trends. 
     
     
         3 . The method of  claim 2 , where the identified data trends are utilized to identify ROI opportunities. 
     
     
         4 . The method of  claim 1 , further including providing root cause analysis of patient claim denials based upon either 835 or 837 type data. 
     
     
         5 . The method of  claim 1 , further including generating a C-Suite level dashboard providing key performance indicators configured to enable strategic management of a revenue cycle. 
     
     
         6 . The method of  claim 3 , further including projecting future ROI if coding training is conducted to correct one or more documented mistakes. 
     
     
         7 . The method of  claim 1 , further including performing analytics comparing client facilities and departments performance by one or more of: payer, RG, and denial code. 
     
     
         8 . The method of  claim 1 , wherein the visual user report includes a cash report segmented into a Daily Cash Collection section and Goal Attainment section. 
     
     
         9 . The method of  claim 1 , wherein the visual user report includes an Age Trial Balance section that segments accounts by Payer, Plan, IP/OP, Age and account number. 
     
     
         10 . The method of  claim 9 , wherein the Age Trial Balance section includes a graph generated on a user's GUI illustrating trends by accounts and balances over a certain prescribed time period relative to a department's account receivables (AR). 
     
     
         11 . A computer system for performing analytics on electronic data containing information regarding inpatient population to identify one or more inpatient records that were coded and/or reimbursed incorrectly so as to generate an electronic report indicating a return-on-investment (ROI) scenario when coding is corrected, comprising:
 a memory configured to store instructions;   a processor disposed in communication with the memory, wherein said processor upon execution of the instructions is configured to:
 utilize one or more of MS-DRG codes and code sets, payer, length of stay, and ICD codes, to determine a preliminary list of inpatient records coded and reimbursed incorrectly; and 
 provide a visual user based report indicating a return-on-investment scenario if the electronic data containing information regarding inpatient population is corrected and rebilled based on user prescribed criteria. 
   
     
     
         12 . The computer system of  claim 11 , wherein the processor is further configured to analyze one or more of accounts receivables data, cash collections data, staff and account productivity data, revenue charge capture data and denials data to identify one or more data trends. 
     
     
         13 . The computer system of  claim 12 , where the identified data trends are utilized to identify ROI opportunities. 
     
     
         14 . The computer system of  claim 11 , wherein the processor is further configured to provide root cause analysis of patient claim denials based upon either 835 or 837 type data. 
     
     
         15 . The computer system of  claim 11 , wherein the processor is further configured to generate a C-Suite level dashboard providing key performance indicators configured to enable strategic management of a revenue cycle. 
     
     
         16 . The computer system of  claim 13 , wherein the processor is further configured to project future ROI if coding training is conducted to correct one or more documented mistakes. 
     
     
         17 . The computer system of  claim 11 , wherein the processor is further configured to perform analytics comparing client facilities and departments performance by one or more of: payer, RG, and denial code. 
     
     
         18 . The computer system of  claim 11 , wherein the visual user report includes a cash report segmented into a Daily Cash Collection section and Goal Attainment section. 
     
     
         19 . The computer system of  claim 1 , wherein the visual user report includes an Age Trial Balance section that segments accounts by Payer, Plan, IP/OP, Age and account number. 
     
     
         20 . The computer system of  claim 19 , wherein the Age Trial Balance section includes a graph generated on a user's GUI illustrating trends by accounts and balances over a certain prescribed time period relative to a department's account receivables (AR).