Post payment provider agreement process

• US 20060190300A1
• Filed: 04/19/2006
• Published: 08/24/2006
• Est. Priority Date: 05/19/2004
• Status: Abandoned Application

• Current Assignee: Mitchell International Incorporated (Mitchell International Holding, Inc.)
• Original Assignee: Fairpay Solutions, Inc. (Mitchell International Holding, Inc.)
• Inventors: Drucker, Vincent
• Application Number:
  US11/406,966
• Publication Number:
  US 20060190300A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/04 Billing or invoicing

Abstract

A method and business technique for reviewing medical service provider bills, recalculating and providing payment recommendation to a paying party for the bills. The method includes analyzing medical bills and determining erroneous and inappropriate charges on bills. The method provides a payment recommendation using multiple databases and sophisticated mathematical modeling that includes one or more of the following: a medical service provider'"'"'s actual cost of delivering the medical services provided; the average profit-margin of that provider, an average profit margin of comparable medical providers in an area, other industry-specific profit-margin benchmarks; an average acceptable payment by medical service providers in the area for comparable services; payment rates negotiated by large health insurers and managed care organizations; and other industry benchmarks for reasonable payment for comparable services.

Claims

1. A method for finalizing an agreement for payment of medical services, said method comprising:

repricing a medical bill from a service provider;

establishing a repriced amount for said medical bill; and

recommending that a payer pay said service provider said repriced amount;

waiting a first predetermined amount of time after the payer has paid the repriced amount and then contacting said service provider to determine whether said service provider accepts said repriced amount as complete payment for said medical bill;

if said service provider accepts said repriced amount as a complete payment for said medical bill then providing at least one of a settlement contract and a zero balance confirmation letter to said service provider for signature;

if said service provider does not accept said repriced amount as a complete payment for said medical bill then negotiating a settlement amount based on at least one specifically identified data point determined during repricing of said medical bill.

2. The method of claim 1, wherein said first predetermined amount of time is between 30 and 120 days.

3. The method of claim 1, wherein repricing comprises:

determining legal and regulatory requirements that apply to said medical bill;

analyzing said medical bill based on the determined legal and regulatory requirements;

determining at least one of erroneous charges, and an actual cost of services on said medical bill; and

providing a repricing recommendation.

4. The method of claim 1, wherein said medical bill is a reconsideration medical bill.

5. The method of claim 1, wherein said at least one specifically identified data point is based on at least one of an unbundling charge, an incorrect CPT code, a charge exceeding a usual payment for services in an associated geographical location, a published medical billing guideline, and a statistical trend analysis result.

6. The method of claim 1, wherein after negotiating a settlement amount, further comprising:

providing at least one of a settlement contract and a zero balance confirmation letter to said service provider for signature if negotiation of said settlement agreement is successful; and

waiting a second predetermined amount of time after negotiating and then contacting said service provider to determine whether said service provider accepts said repriced amount as complete payment for said medical bill.

7. The method of claim 1, wherein after repricing said medical bill, further comprising contacting said service provider and negotiating said repriced amount.

8. A method of establishing a payment amount for a medical service provider, said method comprising:

receiving a medical service provider'"'"'s bill;

performing front-end negotiations and determining a repriced bill;

having said repriced bill paid;

performing back-end negotiations comprising;

contacting said service provider after said repriced bill has been paid and making a first request that said service provider agree to at least one of signing a zero balance confirmation letter and of negotiating said repriced bill;

negotiating, if said service provider agrees to negotiating said repriced bill, said repriced bill to an agreed settlement amount and providing a settlement letter to said service provider;

waiting a predetermined amount of time, if said service provider does not agree to signing said zero balance confirmation letter and does not agree to negotiating said repriced bill, then recontacting said service provider and making a second request that said service provider agree to at least one of signing a zero balance confirmation letter and to negotiating said repriced bill.

9. The method of claim 8, wherein said service provider is one of a medical facility and a medical professional.

10. The method of claim 8, wherein said reconsideration bill requests additional payment for at least one of medical services and medical supplies on said service provider'"'"'s bill.

11. The method of claim 8, wherein said repriced bill requests payment for at least one of additional medical services and additional medical supplies related to said service provider'"'"'s bill.

12. The method of claim 8, further comprising providing a zero balance confirmation letter to said medical service provider for signature by said medical service provider after making said first request.

13. The method of claim 8, wherein said front-end negotiations comprise:

repricing said medical service provider'"'"'s bill by a repricing means.

14. The method of claim 8, wherein said front-end negotiations comprise:

repricing said medical service provider'"'"'s bill using a repricing method into said repriced bill;

contacting said medical service provider to determine whether said medical service provider will negotiate said medical service provider'"'"'s bill,

negotiating said repriced bill with said medical service provider if said medical service provider will negotiate; and

waiting a predetermined amount of time to recontact said service provider if said service provider will not negotiate said repriced bill.

15. The method of claim 14, wherein said repricing method comprises forecasting future and present day medical service provider costs based on collected past, present and historical medical cost and reduced payment information.

16. A method of finalizing a negotiated medical bill payment comprising:

providing, to a medical service provider, a first settlement document prior to paying a negotiated repriced bill to said medical service provider;

receiving, from said medical service provider, a reconsideration bill related to said repriced bill;

reviewing data associated with said negotiated repriced bill;

contacting said medical service provider to determine if said medical service provider will at least one of agree that a zero balance is owed for said reconsideration bill and agree to negotiate said reconsideration bill;

if said medical service provider agrees that a zero balance is owed, then providing a zero balance confirmation letter to said medical service provider;

if said medical service provider will not negotiate said reconsideration bill, then waiting a predetermined amount of time and then contacting said medical service provider again to determine if said medical service provider will negotiate said reconsideration bill;

if said medical service provider will negotiate said reconsideration bill, then negotiating said reconsideration bill using at least one data point associated with a reconsideration bill charge item and then establishing a negotiated reconsideration bill;

providing, to said medical service provider, a second settlement document prior to having said negotiated reconsideration bill paid.

17. The method of claim 16, wherein said medical service provider signs and returns said first settlement document prior to having said negotiated repriced bill paid.

18. The method of claim 16, wherein said medical service provider signs and returns said second settlement document prior to having said negotiated reconsideration bill paid.

19. The method of claim 16, wherein said medical service provider signs and returns said zero balance confirmation letter.

20. The method of claim 16, wherein said predetermined amount of time is 30 to 120 days.