Methods and apparatus for early remittance issue detection

Abstract

Methods and apparatus for detection of remittance issues associated with multiple medical billing claims. Exemplary methods and apparatus involve comparing an expected open rate to an actual open rate for at least one payer to identify at least one bump as a timepoint during the predetermined time range when the actual open rate exceeds the expected open rate. Identified bumps are categorized as a particular category of remittance issue based, at least in part, on a pattern of remittance during the predetermined time range. A user interface displays the pattern of remittance to a user to enable the user to determine an appropriate action to correct an underlying cause of the detected remittance issues.

1 . A method of detecting remittance issues associated with a plurality of medical billing claims, the method comprising acts of:
 calculating, with at least one processor, an expected open rate for at least one payer based, at least in part, on historical remittance received from claims sent to a plurality of payers from a plurality of providers in a claim billing system;   determining an actual open rate for the at least one payer during a predetermined time range based, at least in part on remittance received from claims sent to the at least one payer;   identifying at least one bump as a timepoint during the predetermined time range when the actual open rate exceeds the expected open rate; and   categorizing the at least one bump as a particular category of remittance issue based, at least in part, on a pattern of remittance during the predetermined time range.   
     
     
         2 . The method of  claim 1 , wherein identifying at least one bump comprises identifying a plurality of bumps, wherein the method further comprises:
 determining whether the plurality of bumps are near to each other; and   grouping the plurality of bumps when it is determined that the plurality of bumps are near to each other.   
     
     
         3 . The method of  claim 2 , wherein determining whether the plurality of bumps are near to each other comprises determining whether the bumps are contiguous or near-contiguous in time during the predetermined time range. 
     
     
         4 . The method of  claim 2 , wherein determining whether the plurality of bumps are near to each other comprises determining whether at least some of the claims contributing to the bumps are from the same provider, the same billing batch, and/or the same submission format. 
     
     
         5 . The method of  claim 1 , further comprising:
 assigning at least one score the at least one bump; and   determining whether the at least one score is above a predetermined threshold.   
     
     
         6 . The method of  claim 5 , further comprising:
 discarding the particular category of remittance issue associated with the at least one bump when the at least one score is less than the predetermined threshold.   
     
     
         7 . The method of  claim 5 , wherein the at least one score is selected from a group consisting of a claim volume score, a dollar amount score, and a percentage of daily charges score. 
     
     
         8 . The method of  claim 5 , further comprising:
 calculating the at least one score separately for one or more factors selected from a group consisting of medical group, provider, payer, payer plan, and billing batch.   
     
     
         9 . The method of  claim 1 , further comprising:
 displaying the pattern of remittance during the predetermined time range using at least one user interface that enables a user to select how underlying remittance data for that least one payer is displayed.   
     
     
         10 . At least one computer-readable storage medium encoded with a plurality of instructions, that when executed by a computer, perform a method of detecting remittance issues associated with a plurality of medical billing claims, the method comprising acts of:
 calculating an expected open rate for at least one payer based, at least in part, on historical remittance received from claims sent to a plurality of payers from a plurality of providers in a claim billing system;   determining an actual open rate for the at least one payer during a predetermined time range based, at least in part on remittance received from claims sent to the at least one payer;   identifying at least one bump as a timepoint during the predetermined time range when the actual open rate exceeds the expected open rate; and   categorizing the at least one bump as a particular category of remittance issue based, at least in part, on a pattern of remittance during the predetermined time range.   
     
     
         11 . The at least one computer-readable storage medium of  claim 10 , wherein identifying at least one bump comprises identifying a plurality of bumps, wherein the method further comprises:
 determining whether the plurality of bumps are near to each other; and   grouping the plurality of bumps when it is determined that the plurality of bumps are near to each other.   
     
     
         12 . The at least one computer-readable storage medium of  claim 11 , wherein determining whether the plurality of bumps are near to each other comprises determining whether the bumps are contiguous or near-contiguous in time during the predetermined time range. 
     
     
         13 . The at least one computer-readable storage medium of  claim 11 , wherein determining whether the plurality of bumps are near to each other comprises determining whether at least some of the claims contributing to the bumps are from the same provider, the same billing batch, and/or the same submission format. 
     
     
         14 . The at least one computer-readable storage medium of  claim 10 , further comprising:
 assigning at least one score the at least one bump; and   determining whether the at least one score is above a predetermined threshold.   
     
     
         15 . The at least one computer-readable storage medium of  claim 14 , further comprising:
 discarding the particular category of remittance issue associated with the at least one bump when the at least one score is less than the predetermined threshold.   
     
     
         16 . The at least one computer-readable storage medium of  claim 14 , wherein the at least one score is selected from a group consisting of a claim volume score, a dollar amount score, and a percentage of daily charges score. 
     
     
         17 . The at least one computer-readable storage medium of  claim 14 , further comprising:
 calculating the at least one score separately for one or more factors selected from a group consisting of medical group, provider, payer, payer plan, and billing batch.   
     
     
         18 . The at least one computer-readable storage medium of  claim 10 , further comprising:
 displaying the pattern of remittance during the predetermined time range using at least one user interface that enables a user to select how underlying remittance data for that least one payer is displayed.   
     
     
         19 . A medical billing claim processing system comprising:
 at least one processor programmed to:
 calculate an expected open rate for at least one payer based, at least in part, on historical remittance received from claims sent to a plurality of payers from a plurality of providers in a claim billing system; 
 determine an actual open rate for the at least one payer during a predetermined time range based, at least in part on remittance received from claims sent to the at least one payer; 
 identify at least one bump as a timepoint during the predetermined time range when the actual open rate exceeds the expected open rate; and 
 categorize the at least one bump as a particular category of remittance issue based, at least in part, on a pattern of remittance during the predetermined time range. 
   
     
     
         20 . The medical billing claim processing system of  claim 19 , wherein identifying at least one bump comprises identifying a plurality of bumps, wherein the at least one processor is further programmed to:
 determine whether the plurality of bumps are near to each other; and   grouping the plurality of bumps when it is determined that the plurality of bumps are near to each other.   
     
     
         21 . The medical billing claim processing system of  claim 20 , wherein determining whether the plurality of bumps are near to each other comprises determining whether the bumps are contiguous or near-contiguous in time during the predetermined time range. 
     
     
         22 . The medical billing claim processing system of  claim 20 , wherein determining whether the plurality of bumps are near to each other comprises determining whether at least some of the claims contributing to the bumps are from the same provider, the same billing batch, and/or the same submission format. 
     
     
         23 . The medical billing claim processing system of  claim 19 , wherein the at least one processor is further programmed to:
 assign at least one score the at least one bump; and   determine whether the at least one score is above a predetermined threshold.   
     
     
         24 . The medical billing claim processing system of  claim 23 , wherein the at least one processor is further programmed to:
 discard the particular category of remittance issue associated with the at least one bump when the at least one score is less than the predetermined threshold.   
     
     
         25 . The medical billing claim processing system of  claim 23 , wherein the at least one score is selected from a group consisting of a claim volume score, a dollar amount score, and a percentage of daily charges score. 
     
     
         26 . The medical billing claim processing system of  claim 23 , wherein the at least one processor is further programmed to:
 calculate the at least one score separately for one or more factors selected from a group consisting of medical group, provider, payer, payer plan, and billing batch.   
     
     
         27 . The medical billing claim processing system of  claim 19 , wherein the at least one processor is further programmed to:
 display the pattern of remittance during the predetermined time range using at least one user interface that enables a user to select how underlying remittance data for that least one payer is displayed.