Invention aligns billing codes with payers’ location-specific fee
schedules to help maximize reimbursement
Patent number 8,781,853 applies to “location-driven bill coding,” in which PrimeSUITE populates an EHR with the patient’s payment method and the healthcare provider’s geographic location. When a diagnosis, procedure or evaluation and management code is entered into the EHR, PrimeSUITE automatically assigns an allowed service cost consistent with the payer fee schedule for that provider’s location. This process enables the system to generate bills, insurance claims and patient statements consistent with currently allowed service costs for every billing code associated with a patient’s care.
“The growing complexity of payer models, including variations among payers and U.S. regions, invites increased billing and claim issues that can affect a provider’s revenue position,” said Greenway® CEO Tee Green. “By precisely associating allowed service costs with every electronically captured billing code, PrimeSUITE eliminates a cumbersome manual task and further integrates clinical and billing systems to improve efficiency and alignment with payers. That’s beneficial for providers and payers alike, especially those who deliver services across a wide geography.”
Greenway Health™ delivers the clinical, financial and administrative solutions healthcare providers need to effectively manage the delivery of quality care and improve health outcomes for patient populations. For over 35 years, Greenway has offered smarter solutions that help providers succeed in an evolving value-based healthcare system. Greenway’s clinically driven revenue cycle management™ services and comprehensive suite of interoperable solutions improve financial performance and automate clinical and administrative workflows, so medical providers can spend time on patients instead of paperwork. For more information, visit www.greenwayhealth.com or call (866) 242-3805.
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