METHOD AND SYSTEM FOR DETERMINING A PATIENT'S RESPONSIBILITY TO A PROVIDER

• US 20120143620A1
• Filed: 12/02/2011
• Published: 06/07/2012
• Est. Priority Date: 12/03/2010
• Status: Abandoned Application

• Current Assignee: Phreesia, Inc.
• Original Assignee: Phreesia, Inc.
• Inventors: Linetsky, David, Nathan, Dan, Valla, Edouard
• Application Number:
  US13/309,912
• Publication Number:
  US 20120143620A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

A method and system for determining a patient'"'"'s responsibility to a provider includes a point of service device and a patient responsibility calculator. The point of service device receives information from the patient upon the patient checking in at the provider'"'"'s location. Upon check in, the patient responsibility calculator determines substantially in real-time the amount owed by the patient for a service to be rendered prior to the patient receiving the service. The patient responsibility calculator utilizes information regarding the patient'"'"'s insurance plan from the patient'"'"'s insurance provider to determine the amount owed by the patient for the services. Once the amount owed by the patient is calculated, the point of service device prompts the patient for payment and processes payment.

Claims

1. A system for determining a patient'"'"'s responsibility to a provider comprising:

a point of service device for receiving information from a patient and for processing a payment transaction; and

a patient responsibility calculator in communication with the point of service device, the patient responsibility calculator determining substantially in real-time an amount owed by the patient for a service to be rendered prior to the patient receiving the service.

2. The system of claim 1 wherein the point of service device receives the information from the patient upon the patient checking in at a provider'"'"'s location.

3. The system of claim 1 further comprising a payment processor in communication with the patient responsibility calculator, the payment processor processing payment for the amount owed by the patient.

4. The system of claim 3 wherein the payment processor processes payment prior to the patient receiving the service.

5. The system of claim 3, wherein the point of service device is capable of collecting payment from the patient.

6. The system of claim 1 wherein the patient responsibility calculator further comprises an insurance data processing system receiving information relating to a patient'"'"'s insurance plan from an insurance provider, wherein the patient responsibility calculator utilizes the information from the insurance data processing system to determine the amount owed by the patient.

7. The system of claim 6 wherein the insurance data processing system determines if the patient has insurance, whether the patient'"'"'s insurance is valid and coverage provided by the patient'"'"'s insurance.

8. The system of claim 6 wherein the insurance data processing system receives information relating to a patient'"'"'s insurance plan from a clearinghouse that stores information for a plurality of insurance companies.

9. The system of claim 6 wherein the insurance data processing system is capable of interpreting data from a plurality of insurance companies.

10. The system of claim 9 wherein the insurance data processing system must exceed a predetermined certainty threshold in order to provide insurance coverage information to the patient responsibility calculator.

11. The system of claim 1 further comprising a payment database in communication with the patient responsibility calculator, wherein the payment database stores an amount previously charged to a patient, and wherein the patient responsibility calculator uses the amount previously charged to the patient to determine the amount owed by the patient for the service.

12. The system of claim 1 wherein the patient responsibility calculator utilizes a predetermined provider price list to determine the amount owed by the patient.

13. The system of claim 1 wherein the patient responsibility calculator utilizes a predetermined amount to be charged to a patient for a service to determine the amount owed by the patient.

14. The system of claim 1 wherein the patient responsibility calculator utilizes an outstanding patient balance to determine the amount owed by the patient.

15. The system of claim 1 wherein the patient responsibility calculator receives data from a plurality of provider databases.

16. The system of claim 15, wherein the patient responsibility calculator receives data from the group consisting of a practice management system, a practice finance department and a third party billing company.

17. A method for determining a patient'"'"'s responsibility to a provider, comprising:

receiving patient information at a point of service device from a patient;

receiving insurance information relating to a patient'"'"'s insurance plan from an insurance provider at an insurance data processing system; and

determining, by a patient responsibility calculator, substantially in real-time an amount owed by the patient for a service using the patient information and the insurance information prior to the patient receiving the service.

18. The method of claim 17 further comprising the point of service device performing the steps of:

prompting the patient to pay for the amount owed; and

receiving payment for the amount.

19. The method of claim 17 further comprising the insurance data processing system performing the steps of:

determining if the patient has insurance;

determining whether the patient'"'"'s insurance is valid when the patient has insurance; and

determining coverage provided by the patient'"'"'s insurance when the patient'"'"'s insurance is valid.

20. The method of claim 17 wherein the insurance data processing system receives information relating to a patient'"'"'s insurance plan from a clearinghouse that stores information for a plurality of insurance companies.

21. The method of claim 17 wherein the insurance data processing system is capable of interpreting data from a plurality of insurance companies.

22. The method of claim 21 further comprising the insurance data processing system performing the steps of;

calculating a certainty value of the interpreted data relating to the coverage of the patient'"'"'s insurance plan;

determining if the calculated certainty value exceeds a predetermined certainty threshold; and

providing the insurance coverage information to the patient responsibility calculator when the calculated certainty value exceeds the predetermined certainty threshold.

23. The method of claim 17 wherein the step of determining substantially in real-time the amount owed by the patient for a service further comprises using an amount previously charged to the patient for the service.

24. The method of claim 17 wherein the step of determining substantially in real-time the amount owed by the patient for the service further comprises utilizing a predetermined provider price list.

25. The method of claim 17 wherein the step of determining substantially in real-time the amount owed by the patient for the service further comprises utilizing a predetermined provider-set amount to be charged to a patient.

26. The method of claim 17 wherein the step of determining substantially in real-time the amount owed by the patient for the service further comprises utilizing any outstanding patient balance.

27. The method of claim 18 further comprising the step of:

storing, by the patient responsibility calculator, a status of payment made for use in future calculations.

28. A system for determining a patient'"'"'s responsibility to a provider comprising:

a point of service device for receiving information from a patient and for processing a payment transaction; and

an insurance data processing system in communication with the point of service device, the insurance data processing system receiving information regarding a patient'"'"'s insurance plan from an insurance provider, and prior to the patient receiving services, determining substantially in real-time an amount owed by the patient for the services.