System and Method for Coordinating Payment for Healthcare Services

• US 20140122108A1
• Filed: 10/25/2013
• Published: 05/01/2014
• Est. Priority Date: 10/25/2012
• Status: Abandoned Application

• Current Assignee: Analyte Health, Inc.
• Original Assignee: Analyte Health, Inc.
• Inventors: Malven, Daniel Paul, Chism, Leon Taylor II, Kolovos, Vasili Michael, Rogers, Mark Aaron, London, Jesse Solomon, Weber, Justin Charles, Wise, Mark Robert, Aston, Mark Evan, Keefe, Lisa
• Application Number:
  US14/063,706
• Publication Number:
  US 20140122108A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 20/14 specially adapted for billing systems
• CPC Class Codes: G16H 10/40 for data related to laboratory analysis, e.g. patient specimen analysis
• CPC Class Codes: G16H 15/00 ICT specially adapted for medical reports, e.g. generation or transmission thereof
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems
• CPC Class Codes: G16H 70/20 relating to practices or guidelines

Abstract

A computer-implemented system and method for coordinating payment for healthcare services are provided. Demographic and insurance information associated with a patient user, a request for medical advice, and a responses to queries provided by the patient user are received from a first computer device. A test plan is developed for the patient user. A prescription for the test plan is created and transmitted to a second computing device associated with an entity that executes the prescription, and test results are received from the second computing device. Medical advice is determined in accordance with at least one of the demographic information associated, the responses, and the test results. A claim is generated and transmitted to an insurance claim adjudication system. Payment for charges paid by an insurance provider is received and an invoice for charges paid by the patient user is sent to a payment system associated with the patient user.

Claims

1. A computer-implemented system for coordinating payment for healthcare services, comprising:

a patient communication engine that receives from a first computer device demographic information associated with a patient user, insurance information associated with the patient user, a request for medical advice associated with the patient user, and a plurality of responses to queries provided by the patient user;

a physicians engine that selects a physician to associate with the patient user, wherein the physician is selected in accordance with at least one of the demographic information, the insurance information, and the plurality of responses;

a diagnostics engine that analyzes at least one of the plurality of responses, payment information, physician information, and the demographic information to develop a test plan for the patient user;

a prescription engine that creates a prescription for the test plan and transmits the prescription to a second computing device associated with an entity that executes the prescription for the test plan;

a results analysis engine that receives from the second computing device test results of the patient user associated with the prescription;

a medical advice engine that determines in accordance with at least one of the demographic information, the plurality of responses and the test results, medical advice that the physician will communicate to the patient user;

an insurance engine that automatically generates a claim for at least one of developing the test plan, executing the prescription for the test plan, and providing medical advice; and

a billing engine that;

transmits the generated claim to an insurance claim adjudication system,

receives payment for a first portion of the charges associated with the medical test paid by an insurance provider, and

generates and transmits to a payment system associated with the patient user an invoice for a second portion of the charges associated with the medical test that are the responsibility of the patient user.

2. The system of claim 1, wherein the insurance engine further:

transmits information regarding the test plan to an insurance benefits system in accordance with the insurance information; and

develops an estimate of charges associated with the medical test for which the patient user will be responsible in accordance with at least one of the insurance information and the response from the insurance benefits system.

3. The system of claim 2, wherein the insurance engine further waits a predetermined amount of time for a response from the insurance benefits system, wherein the response includes coverage information for the patient user;

and if the predetermined period of time expires before the response is received from the insurance benefits system, the insurance engine determines insurance coverage for the patient user in accordance with the insurance information and develops an estimate of charges in accordance with the determined insurance coverage.

4. The system of claim 2, wherein the insurance engine transmits information regarding the medical test to one of a practice management system, a revenue cycle management system, an insurance gateway, or an insurance clearinghouse.

5. The system of claim 2, wherein the insurance engine transmits to the insurance benefits system data in accordance with the ASC X12N EDI Transaction Standard.

6. The system of claim 2, further comprising a cost estimate engine that analyses data received from the insurance benefits system to develop an estimate of a maximum cost for services.

7. The system of claim 6, wherein the patient communication engine transmits to the first computer the estimate of the maximum cost for services, and the prescription engine automatically creates the prescription only if the patient communication engine receives authorization from the first computer device.

8. The system of claim 1, wherein the claim comprises a CPT code and an International Classification of Diseases (ICD) code.

9. The system of claim 8, wherein the CPT code is a code associated with one of evaluation and management, specimen collection, and a lab.

10. The system of claim 8, wherein the ICD code is a code associated with one of a symptom, contact with a disease, test for a bacterial infection, screening for a viral disease, and screening for a lifestyle related disease.

11. A computer-implemented method for coordinating payment for healthcare services, comprising:

receiving, from a first computer device demographic information associated with a patient user, insurance information associated with the patient user, a request for medical advice associated with the patient user, and a plurality of responses to queries provided by the patient user;

selecting a physician to associate with the patient user, wherein the physician is selected in accordance with the insurance information and regulations of a jurisdiction associated with the location of the patient user;

analyzing at least one of the plurality of responses, payment information, physician information, and demographic information to develop a test plan for the patient user;

creating a prescription for the test plan and transmitting the prescription to a second computing device associated with an entity that executes the prescription;

receiving from the second computing device test results of the patient user associated with the prescription;

determining in accordance with at least one of the demographic information, the plurality of responses, and the test results, medical advice that the physician will communicate to the patient user;

generating automatically a claim for at least one of developing the test plan, executing the prescription for the test plan, and providing medical advice;

transmitting the generated claim to an insurance claim adjudication system;

receiving payment for a first portion of the charges associated with the medical test paid by an insurance provider; and

generating and transmitting to a payment system associated with the patient user an invoice for a second portion of the charges associated with the medical test that are a responsibility of the patient user.

12. The method of claim 11, further comprising:

transmitting information regarding the test plan to an insurance benefits system in accordance with the insurance information; and

developing an estimate of charges associated with the medical test for which the patient user will be responsible in accordance with at least one of the insurance information and the response from the insurance benefits system.

13. The method of claim 12, further comprising waiting a predetermined amount of time for a response from the insurance benefits system, wherein the response includes coverage information for the patient user;

and if the predetermined amount of time expires before a response is received from the insurance benefits system, determining insurance coverage for the patient user in accordance with the insurance information and developing an estimate of charges in accordance with the determined insurance coverage.

14. The method of claim 12, wherein transmitting information regarding the test plan to the insurance benefits system comprises transmitting information regarding the test plan to one of a practice management system, a revenue cycle management system, an insurance gateway, or an insurance clearinghouse.

15. The method of claim 12, wherein transmitting information to the insurance benefits system comprises transmitting data in accordance with the ASC X12N EDI Transaction Standard.

16. The method of claim 12, further comprising developing an estimate of a maximum cost for services by analyzing data received from the insurance benefits system.

17. The method of claim 16, further comprising transmitting to the first computer device the estimate of the maximum cost for services, and creating the prescription only if authorization is received from the first computer device.

18. The method of claim 11, wherein the claim comprises a CPT code and an International Classification of Diseases (ICD) code.

19. The method of claim 18, wherein the CPT code is a code associated with one of evaluation and management, specimen collection, and a lab.

20. The method of claim 18, wherein the ICD code is a code associated with one of a symptom, contact with a disease, test for a bacterial infection, screening for a viral disease, and screening for a lifestyle related disease.