Our client provides medical billing and accounts receivable management services to clients across the USA. This is a highly specialized field in which they have to deal with constantly changing regulations and other factors that are unique to this profession. Their company includes several distant offices on two different continents with more than a hundred workers processing more than a million patient accounts per year.
The initial problem involved finding the right design pattern and technologies. The data syncing between offices was too complex for our purposes, so the data needed to be stored to a single, central location. Deciding between a web and a smart client application, the latter was picked based on the benchmarking and assessment of the data entry speed and flexibility of doing a portion of data processing directly on employees' workstations. Every part of a rather complex bussiness workflow was covered with a separate, independent module - from the initial receiving of the hospital paperwork and patient data entry, through the coding, insurance and patient billing, to the follow-up and collection/write-off of the remaining debt.
Aside from the conventional GUI and RDBMS designed to mimic our client's workflow, there were numerous special tasks that required careful investigation and implementation of a proper technology. A barcoding generation and recognition was used for processing piles of scanned hospital paperwork and separating the pages related to each individual patient. A purchased electronic data interchange (EDI) component helped to develop a complex programming logic of the required EDI 837 and 835 industry standards for electronic medical claim billing and receiving of the electronic remittance advice (ERA). A special reporting technology helped with the correct rendering of the required paper (HCFA) claims where various insurance companies would deny a claim due to an incorrect positioning, alignment, or event font size and weight. A dynamic set of rules was applied in order to satisfy a miryad of specific insurance company dictated billing requirements that were not part of the standard set of rules (covered by the government HIPAA medical billing act).
Reporting and analytics section covers a wide range of scenarios, from controlling workers efficiency to contractual obligation of giving a set of reports to our partner company's own clients. A high number of reports and their constant upgrading and development was expected due to the policy of satisfying each of their client's doctors in his/her specific desires for procedure statistics, revenue tracking or any other kind of analytical information. Hence several different reporting technologies were utilized, depending on which one was most suitable or fastest to develop for a certain scenario.
Public part of the application includes a client portal web interface for doctors being able to directly perform patient account inquiries and run reports, as well as a patient web interface for making credit card payments for their medical bills.