| CPC G16H 40/20 (2018.01) [G16H 15/00 (2018.01)] | 17 Claims |
|
1. An International Statistical Classification of Diseases and Related Health Problems (ICD) code prioritization system, comprising:
a server having a system processor running a healthcare charge module configured to, in order to process and prioritize disease and related health problem codes, order and rank ICD codes by:
receiving an approval or rejection of one or more ICD codes in a submitted claim;
incrementing an ICD code rank for the approved ICD code and incrementing an approval count, if an ICD code is approved;
decrementing the ICD code rank for the denied ICD code and incrementing a denial count, if an ICD code is denied;
storing the ICD code rank, the incremented approval or denial count, and a timestamp of the approval or disapproval for the received approval or rejection;
creating a baseline rank for ICD codes not having a stored rank;
retrieving a history of approved ICD codes and denied ICD codes for a predetermined time frame;
ordering each ranked ICD code;
incrementing the ICD code rank for the approved ICD code, otherwise, analyzing the ICD code approval amount, if a number of approved ICD codes surpasses a first threshold;
decrementing the ICD code rank for a denied ICD code;
incrementing and storing the ICD code rank for an approved ICD code,
otherwise, storing the ICD code rank, if the ICD code approval amount surpasses a second threshold;
decrementing and storing the ICD code rank for a denied ICD code, otherwise, storing the ICD code rank, if the ICD code is approved and under said second threshold or denied;
incrementing an ICD code rank for an approved ICD code and incrementing an approval count for the number of approved ICD codes;
generating a new claim based on each ICD code, incremented ICD codes, ranked ICD codes, ICD approval counts, ICD code approval amount, denied ICD codes, or a combination thereof, related to one or more procedures, diseases, related health problems, or a combination thereof; and
submitting said claim to a payor for payment with an ordered rank of ICD codes prioritized highest to lowest increment or ranked order.
|