helping clinical providers and medical billers reduce inefficiency and improve accuracy of healthcare reimbursement
Accurate coding, billing, and reimbursement are essential to the viability of medical practices. Each process requires coordination and proper documentation from both administrative personnel and clinical providers and uses multiple platforms to access the required data.
But because these functions are primarily done manually, error rates are high and there are often delays that result in the billing lagging significantly behind clinical care. In addition, specialized billing departments can result in substantial administrative costs.
University of Michigan team Michael Burns, M.D., Ph.D., and John Vandervest, M.S., developed an automated medical billing platform that could decrease the time and effort used to process and audit claims, leading to operational efficiencies and the ability to maximize revenue while maintaining billing compliance.
The new platform integrates the various required billing data streams into a single platform that will pull data from multiple Electronic Medical Record resources and process them through a Current Procedure Terminology (CPT) prediction model. The platform then provides a subset of CPT codes with confidence intervals to billers for manual processing. This ability to subset a portion of a billing department’s total workflow could minimize, or eradicate, the need for manual review on high-volume, low-complexity cases.
“As a standalone product, this tool could aid in the auditing process, as well as be integrated directly into the billing workflow,” says Burns. “We are currently using this model within the U-M anesthesiology billing department and seeing excellent results.”
The team sees an opportunity to extend the product beyond anesthesiology into surgery and E&M coding, as well as to a wide commercial audience.
Significant Need
Current billing processes require a human billing professional to review each case independently. This can lead to frequent delays and billing errors.
Compelling Science
The product integrates the data streams needed for billing into a single platform and can allow prioritization of workflow to the cases with the most complicated billing requirements.
Competitive Advantage
A low cost, high-volume tool for providers that benefits all sides of the medical reimbursement landscape – providers, medical billers, and insurance companies. This platform could allow existing billing personnel to redistribute their efforts more effectively, while also providing an efficient means of auditing institutional billing services. This platform was built on data from more than 50 institutions across the U.S., which allows new customers to adopt this platform while maintaining the platform’s high accuracy.
Overall Commercialization
- Commercialization Strategy: Seeking out-licensing or partnership agreements with existing medical software and medical billing companies.
- Intellectual Property: Non-provisional patent filed for analytical methods and applications.
- Regulatory Pathway: No FDA regulation required. Platform complies with HIPAA and related data security and privacy requirements.
- Product Launch Strategy: Initial target market in anesthesiology billing, with planned expansion into surgical billing and other clinical areas.
Milestones
- Integrate CPT predictions into existing biller workflow
- Develop Audit Dashboard for post-billing review and correction
- Develop Coder Performance Dashboard for training and workflow redistribution purposes
- Pilot the platform at a 2nd institutional site
