Financial analysis of healthcare service agreements
First Claim
1. A method of determining a financial outcome under a provider-payer healthcare services agreement, the method comprising:
- providing a first set of generally classified healthcare service utilization data;
providing a first set of specifically categorized healthcare service utilization data;
creating a second set of generally classified healthcare service utilization data based at least upon the first set of specifically categorized healthcare service utilization data;
creating a third set of generally classified healthcare service utilization data;
scaling the first set of specifically categorized healthcare service utilization data based at least upon the third set of generally classified healthcare service utilization data to produce a second set of specifically categorized healthcare service utilization data; and
applying a rate schedule to the second set of specifically categorized healthcare service utilization data to determine a financial outcome.
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0 Petitions
Accused Products
Abstract
Rate schedules specify payment mechanisms and rates based upon which healthcare service providers are compensated for services by insurers. The invention provides a tool for predicting the total compensation under a rate schedule based upon expected levels of service utilization for a provider during a time period. Service utilization levels characteristic of the provider are supplied for a relatively small number of general classes of medical services. Aggregate utilization data that is collected from multiple service providers by government authorities provides a reliable distribution of data that is based upon a large population and that is specifically categorized using hundreds of DRG codes. The specifically categorized aggregate utilization data is scaled based upon the general utilization levels of the provider to create a predicted set of service utilization data. The rate schedule is applied to the predicted set of service utilization data to determine total compensation.
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Citations
20 Claims
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1. A method of determining a financial outcome under a provider-payer healthcare services agreement, the method comprising:
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providing a first set of generally classified healthcare service utilization data;
providing a first set of specifically categorized healthcare service utilization data;
creating a second set of generally classified healthcare service utilization data based at least upon the first set of specifically categorized healthcare service utilization data;
creating a third set of generally classified healthcare service utilization data;
scaling the first set of specifically categorized healthcare service utilization data based at least upon the third set of generally classified healthcare service utilization data to produce a second set of specifically categorized healthcare service utilization data; and
applying a rate schedule to the second set of specifically categorized healthcare service utilization data to determine a financial outcome. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10)
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11. A method of determining a financial outcome under a provider-payer healthcare services agreement, the method comprising:
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providing a first set of healthcare service utilization data;
providing a second set of healthcare service utilization data;
scaling the second set of healthcare service utilization data based at least upon the first set of service utilization data to produce a third set of service utilization data; and
applying a rate schedule to the third set of healthcare service utilization data to determine a financial outcome. - View Dependent Claims (12, 13, 14, 15, 16, 17, 18)
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19. A method of determining a financial outcome under a provider-payer healthcare services agreement, the method comprising:
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creating a set of aggregate healthcare service utilization data based at least upon encounter-level data obtained from a governmental entity;
scaling the set of aggregate healthcare service utilization data to obtain a set of predictive healthcare service utilization data; and
applying a rate schedule to the set of predictive healthcare service utilization data to determine a financial outcome. - View Dependent Claims (20)
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Specification