Method and system to analytically optimize telehealth practice-based billing processes and revenue while enabling regulatory compliance
Inventors
Mason, Steven • Posnack, Daniel • Arn, Peter • Para, Wendy • Hacking, S. Adam • Mueller, Micheal • GUANERI, Joseph • Greene, Jonathan
Assignees
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Publication Number
US-12340884-B2
Publication Date
2025-06-24
Expiration Date
Abstract
A computer-implemented system includes a treatment apparatus configured to be manipulated by a patient while performing a treatment plan and a server computing device configured to execute an artificial intelligence engine to generate the treatment plan and a billing sequence associated with the treatment plan. The server computing device receives information pertaining to the patient, generates, based on the information, the treatment plan including instructions for the patient to follow, and receives a set of billing procedures associated with the instructions. The set of billing procedures includes rules pertaining to billing codes, timing, constraints, or some combination thereof. The server computing device generates, based on the set of billing procedures, the billing sequence for at least a portion of the instructions. The billing sequence is tailored according to a certain parameter. The server computing device transmits the treatment plan and the billing sequence to a computing device.
Core Innovation
The invention relates to a telehealth system in which an artificial intelligence engine generates a patient treatment plan and a billing sequence associated with the treatment plan. The treatment plan is generated based on medical diagnosis code information pertaining to the patient, and comprises a plurality of instructions for the patient that is associated with a set of billing procedures comprising one or more rules pertaining to one or more billing codes, timing, constraints, or some combination thereof.
The server computing device generates, based on the set of billing procedures, the billing sequence for at least a portion of the plurality of instructions. The billing sequence is determined in part by using at least one parameter, and the treatment plan and the billing sequence are transmitted to a computing device. In example refinement, the billing sequence is modified based on requests to cause funds to be received sooner and/or yield optimized funds received while maintaining billing compliance through the billing-procedure rules.
The system also controls an electromechanical machine while the patient performs the treatment plan by modifying one or more operating parameters of the electromechanical machine based on the treatment plan. Based on the patient’s completed performance, the system determines at least one billable session comprising the treatment plan, and provides an indication that billing is allowed and information comprising billing codes associated with the session. The system presents the treatment plan and billing sequence in real-time or near real-time during a telemedicine session, including on a medical professional’s computing device, and the constraints can include constraints specified in regulations and/or laws.
Claims Coverage
The independent claims are clm-00001, clm-00010, and clm-00019. Across these independent claims, the coverage includes five core inventive components: AI-based generation of a treatment plan and an associated billing sequence from diagnosis code information and billing-procedure rules, parameter-based determination of the billing sequence, transmission of the treatment plan and billing sequence, control of an electromechanical machine during patient performance, and determination of billable sessions with billing allowed and associated billing codes.
Ai-generated treatment plan tied to billing procedures
Generates, based on medical diagnosis code information which pertains to the patient, the treatment plan for the patient, wherein the treatment plan comprises a plurality of instructions for the patient, and further wherein the plurality of instructions is associated with a set of billing procedures which comprise one or more rules pertaining to one or more billing codes, timing, constraints, or some combination thereof.
Parameter-determined billing sequence from billing procedures
Generates, based on the set of billing procedures, the billing sequence for at least a portion of the plurality of instructions, wherein the billing sequence is determined in part by using at least one parameter.
Transmission of treatment plan and billing sequence
Transmits the treatment plan and the billing sequence to a computing device.
Control of electromechanical machine based on treatment plan
Controlling, based on the treatment plan, operation of the electromechanical machine by modifying one or more operating parameters of the electromechanical machine while the patient performs the treatment plan.
Billable-session determination and billing-allowed indication
Determining, based on the patient's completed performance at least one billable session that comprises the treatment plan, an indication that billing is allowed and information comprising billing codes associated with the session.
The independent claims collectively cover an AI engine that generates a diagnosis-code-based treatment plan whose instructions are associated with billing-procedure rules, derives a billing sequence from those rules using at least one parameter, transmits the plan and billing sequence, controls an electromechanical machine by modifying operating parameters during patient performance, and then determines billable sessions with an indication that billing is allowed along with the associated billing codes.
Stated Advantages
Causes funds to be received sooner.
Optimizes a total amount of funds being received.
Optimizes a number of payments being received.
Optimizes a schedule for receiving the funds.
Documented Applications
Telemedicine/telehealth sessions in which the treatment plan and billing sequence are presented and used to control an electromechanical machine during patient performance.
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