AUTOMATED TECHNICAL AND PROFESSIONAL FEE BILLING PROGRAM

Many laboratories in large clinics and teaching hospitals lack an automated bill paying system, yet every unit that provides health care services must generate a bill for services rendered. The bill is typically divided into two parts: a technical fee and a professional fee. An enormous amount of documentation is required in order to satisfy the third party that ultimately pays the bill. For example, the proper identification of the physician who ordered the test, the CPT code for the procedure performed, the IDC9 code for the diagnosis of the patient, plus various identification numbers and insurance codes must be provided correctly or else the bill will not be paid by the third party. Typically, such information is manually entered into the hospital's computer system in order to generate records and bills.

UCSF researchers have recently developed a program to automate the interface between text invoice files and the IDX hospital billing system. Files containing information required for technical and professional fees are processed through a text parser, which extracts billing information and generates a file in HL7 format that can be used to charge for technical and professional fees. Prior to creation of the final charge file, the bill file processing permits review of individual third party payer requirements and adjusts the charge file accordingly. After creation, the charge files are sent to the hospital's computer system by FTP for batch processing. The professional fee portion of the program also indicates to the billing agent which bills may be transmitted electronically to the third party payer, which bills must be sent in hard copy, and which bills require a copy of the report and/or letter of justification. The system currently in use at UCSF has resulted in significantly higher collection rates for both technical and professional fees, and such systems can be easily adapted to other hospitals' and service providers' existing computer systems

If you would like to receive further information about this technology and potential licensing opportunities, please contact:

Michael Karasik
Administrative Manager
(415) 353-4472 phone
(415) 348-1579 fax
Michael Karasik@ucsf.edu

Reference: OTM Case #SF02-092