Medical payment system

• US 7,346,522 B1
• Filed: 01/08/2003
• Issued: 03/18/2008
• Est. Priority Date: 01/08/2002
• Status: Active Grant

• Current Assignee: First Access, Inc. (WEX Inc.)
• Original Assignee: First Access, Inc. (WEX Inc.)
• Inventors: Baylor, Dorothy M., Darling, Kimberly A.
• Primary Examiner(s): Zeender; F.
• Assistant Examiner(s): Frenel; Vanel
• Application Number:
  US10/338,965
• Time in Patent Office: 1,896 Days
• Field of Search: 705 2- 4, 705/40, 235/380
• US Class Current: 705/3
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 20/102 Bill distribution or payments
• CPC Class Codes: G06Q 20/14 specially adapted for billing systems
• CPC Class Codes: G06Q 40/02 Banking, e.g. interest calculation or account maintenance credit or loans G06Q40/03
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/65 stored on portable record carriers, e.g. on smartcards, RFID tags or CD

Abstract

A medical payment system is described in which a provider of medical goods and/or services submits, via telephone or other communications medium, a request for payment amount determination for a patient encounter. A price determination system determines which of a plurality of fee schedules negotiated by the provider applies to the patient encounter and calculates, based at least in part on information entered by the provider, a payment amount for the encounter, which it communicates to at least the provider. In one embodiment, the provider receives the payment amount information while the patient is at the point of service. In one embodiment, the provider may use the system to submit a claim for payment by at least one responsible party.

Claims

1. A computer-implemented method of determining healthcare prices, comprising:

prompting a medical provider with an interactive voice response system to enter information about a patient encounter wherein said interactive voice response system is configured to verbally prompt said medical provider for patient identification information, medical provider identification information, and goods or services information;

receiving, via said interactive voice response system said patient identification information, said medical provider information, and said goods or services information;

determining a contracted payment amount associated with said goods or services wherein determining said contracted payment amount comprises;

selecting a fee schedule, from amongst a hierarchy of fee schedules, to use for calculating said payment amount by accessing a priority list that assigns a ranking to said fee schedules; and

calculating said contracted payment amount based on said selected fee schedule; and

communicating via said interactive voice response system said contracted payment amount to at least said medical provider.

2. The computer-implemented method of claim 1, further comprising receiving information about a zip code associated with said medical provider.

3. The computer-implemented method of claim 2, wherein determining a contracted payment amount is based at least in part on said zip code information.

4. The computer-implemented method of claim 1, wherein accessing information about a hierarchy of fee schedules comprises accessing a priority list that assigns a ranking to each of a plurality of fee schedules.

5. The computer-implemented method of claim 1, wherein determining which fee schedule to use comprises selecting, from amongst said plurality of fee schedules negotiated with said medical provider, a fee schedule assigned a highest ranking in said priority list.

6. The computer-implemented method of claim 1, further comprising determining a portion of said contracted payment amount to be paid by said patient and a portion of said contracted payment amount to be paid from a source of medical funds.

7. The computer-implemented method of claim 6, wherein said source of medical funds is a third-party payor.

8. The computer-implemented method of claim 6, wherein said source of medical funds is a medical insurance company.

9. The computer-implemented method of claim 6, wherein said source of medical funds is a Flexible Savings Account.

10. The computer-implemented method of claim 6, wherein said source of medical funds is a purse available for payment of said patient'"'"'s medical expenses.

11. The computer-implemented method of claim 6, wherein said source of medical funds is a medical credit card account associated with said patient.

12. The computer-implemented method of claim 6, further comprising communicating with said source of medical funds about said patient encounter.

13. The computer-implemented method of claim 12, wherein communicating with said source of medical funds comprises submitting a claim for payment of said portion of said payment amount to be paid by said source of medical funds.

14. The computer-implemented method of claim 12, wherein communicating with said source of medical funds comprises providing information that allows payment to be sent from said source of medical funds to said medical provider.

15. A computer-implemented method of determining healthcare prices, comprising:

prompting a medical provider with an interactive voice response system to enter information about a patient encounter wherein said interactive voice response system is configured to verbally prompt said medical provider for patient identification information, medical provider identification information and goods or services information;

receiving via a telephone keypad said patient identification information, said medical provider identification information and said goods or services information;

determining at least one provider organization affiliated with said medical provider;

selecting a fee schedule amongst a hierarchy of fee schedules for said patient encounter based on a priority list of provider organizations wherein said priority list assigns a ranking to said fee schedules and based on said provider organization affiliated with said medical provider;

calculating a payment amount associated with said patient encounter based on said selected fee schedule; and

communicating via said interactive voice response system said payment amount to at least said medical provider.

16. The computer-implemented method of claim 15, wherein determining at least one fee schedule comprises selecting at least one fee schedule, from amongst a plurality of fee schedules negotiated with said provider organization, to use for calculating said payment amount.

17. The computer-implemented method of claim 15, wherein selecting at least one fee schedule to use comprises selecting, from amongst said plurality of fee schedules negotiated with said provider organizations, a fee schedule assigned a highest ranking in said priority list.

18. The computer-implemented method of claim 15, further comprising determining a portion of said payment amount to be paid by said patient and a portion of said payment amount to be paid from a source of medical funds.

19. The computer-implemented method of claim 18, wherein said source of medical funds is a third-party payor.

20. The computer-implemented method of claim 18, wherein said source of medical funds is a medical insurance company.

21. The computer-implemented method of claim 18, wherein said source of medical funds is a Flexible Savings Account.

22. The computer-implemented method of claim 18, wherein said source of medical funds is a purse available for payment of said patient'"'"'s medical expenses.

23. The computer-implemented method of claim 18, wherein said source of medical funds is a medical credit card account associated with said patient.

24. The computer-implemented method of claim 18, further comprising communicating with said source of medical funds about said patient encounter.

25. The computer-implemented method of claim 24, wherein communicating with said source of medical funds comprises submitting a claim for payment of said portion of said payment amount to be paid by said source of medical funds.

26. The computer-implemented method of claim 24, wherein communicating with said source of medical funds comprises providing information that allows payment to be sent from said source of medical funds to said provider.

27. a computer-implemented method of determining healthcare prices, comprising:

receiving information entered about a patient encounter with a medical provider, wherein said information identifies a patient, said medical provider and goods or services;

determining with a computer a plurality of provider organizations that are affiliated with said medical provider;

selecting with a computer at least one fee schedule associated with said patient encounter from amongst a hierarchy of fee schedules, by accessing a priority list that assigns a priority ranking to said fee schedules, wherein said selecting of said fee schedule is based on said priority ranking of fee schedules and based on said provider organizations that are affiliated with said medical provider;

calculating said contracted payment amount associated with said patient encounter based on said selected fee schedule; and

communicating said calculated contracted payment amount to at least said medical provider.

28. The computer-implemented method of claim 27, wherein calculating said contracted payment amount and communicating said calculated payment amount to at least said medical provider occurs in real time.

29. The computer-implemented method of claim 27, wherein calculating said contracted payment amount and communicating said calculated payment amount to at least said medical provider occurs while said patient waits with said medical provider.

30. The computer-implemented method of claim 27, wherein selecting at least one fee schedule to use comprises selecting, from amongst said plurality of fee schedules negotiated with said provider organizations, a fee schedule assigned a highest ranking in said priority list.

31. The computer-implemented method of claim 27, further comprising determining a portion of said payment amount to be paid by said patient and a portion of said payment amount to be paid from a source of medical funds.

32. The computer-implemented method of claim 31, wherein said source of medical funds is a third-party payor.

33. The computer-implemented method of claim 31, wherein said source of medical funds is a medical insurance company.

34. The computer-implemented method of claim 31, wherein said source of medical funds is a Flexible Savings Account.

35. The computer-implemented method of claim 31, wherein said source of medical funds is a purse available for payment of said patient'"'"'s medical expenses.

36. The computer-implemented method of claim 31, wherein said source of medical funds is a medical credit card account associated with said patient.

37. The computer-implemented method of claim 31, further comprising communicating with said source of medical funds about said patient encounter.

38. The computer-implemented method of claim 37, wherein communicating with said source of medical funds comprises submitting a claim for payment of said portion of said contracted payment amount to be paid by said source of medical funds.

39. The computer-implemented method of claim 37, wherein communicating with said source of medical funds comprises providing information that allows payment to be sent from said source of medical funds to said provider.

40. A computer-implemented healthcare price determination system, comprising:

an interactive voice response system that is configured to verbally prompt a medical provider to enter information about a patient encounter, said information comprising patient identification information, medical provider identification information, and goods or services information and wherein said interactive voice response system is further configured to receive said patient identification information, said medical provider information and said goods or services information;

a price determination processor that is configured to calculate said contracted payment amount associated with said patient encounter wherein said price determination processor is further configured to select a fee schedule from amongst a hierarchy of fee schedules to use in calculating said payment amount by accessing a priority list that assigns a ranking to said fee schedules and wherein said price determination processor is further configured to calculate said contracted payment amount based on said selected fee schedule; and

wherein said interactive voice response system is configured to communicate said calculated contracted payment amount to at least said medical provider.

41. The computer-implemented healthcare price determination system of claim 40, wherein said interactive voice response system is configured to receive information entered via a telephone keypad.

42. The computer-implemented healthcare price determination system of claim 40, wherein said interactive voice response system is configured to receive information spoken into a telephone.

43. The computer-implemented healthcare price determination system of claim 40, further comprising a fax response system that is configured to communicate said calculated payment amount to at least said medical provider.

44. The computer-implemented healthcare price determination system of claim 40, wherein said price determination processor is further configured to select a fee schedule to use by selecting, from amongst said plurality of fee schedules, a fee schedule assigned a highest ranking in said priority list.

45. The computer-implemented healthcare price determination system of claim 40, wherein said price determination processor is further configured to determine a portion of said contracted payment amount to be paid by said patient and a portion of said contracted payment amount to be paid from a source of medical funds.

46. The computer-implemented healthcare price determination system of claim 45, wherein said source of medical funds is a third-party payor.

47. The computer-implemented healthcare price determination system of claim 45, wherein said source of medical funds is a medical insurance company.

48. The computer-implemented healthcare price determination system of claim 45, wherein said source of medical funds is a Flexible Savings Account.

49. The computer-implemented healthcare price determination system of claim 45, wherein said source of medical funds is a purse available for payment of said patient'"'"'s medical expenses.

50. The computer-implemented healthcare price determination system of claim 45, wherein said source of medical funds is a medical credit card account associated with said patient.

51. The computer-implemented healthcare price determination system of claim 45 further comprising a claim submission system that is configured to communicate with said source of medical funds about said patient encounter.

52. The computer-implemented healthcare price determination system of claim 51, wherein said claim submission system is further configured to communicate with said source of medical funds by submitting a claim for payment of said portion of said payment amount to be paid by said source of medical funds.

53. The computer-implemented healthcare price determination system of claim 51, wherein said claim submission system is further configured to transmit information to said source of medical funds that allows payment to be sent from said source of medical funds to said medical provider.

54. An apparatus for determining healthcare prices, the apparatus comprising:

an interactive voice response system that is configured to verbally prompt said medical provider for patient identification information, medical provider identification information and goods or services information;

processor circuitry configured to receive from a telephone keypad said patient identification information, said medical provider information and said goods or services information;

wherein said processor circuitry is further configured to determine a plurality of provider organizations affiliated with said medical provider;

wherein said processor circuitry is further configured to select at least one fee schedule amongst a hierarchy of fee schedules for said patient encounter based on a priority list of provider organizations wherein said priority list assigns a ranking to said fee schedules and based on said provider organization affiliated with said medical provider;

wherein said processor circuitry is further configured to calculate a payment amount associated with said patient encounter based on said selected fee schedule; and

wherein said processor circuitry is further configured to communicate via said voice response system said payment amount to at least said medical provider.

55. The apparatus of claim 54, wherein said processor circuitry that selects said fee schedule to use is further configured to selected, from amongst said plurality of fee schedules, a fee schedule assigned a highest ranking in said priority list.

56. The apparatus of claim 54, wherein said processor circuitry is further configured to determine a portion of said payment amount to be paid by said patient and a portion of said payment amount to be paid from a source of medical funds.

57. The apparatus of claim 56, wherein said source of medical funds is a third-party payor.

58. The apparatus of claim 56, wherein said source of medical funds is a medical insurance company.

59. The apparatus of claim 56, wherein said source of medical funds is a Flexible Savings Account.

60. The apparatus of claim 56, wherein said source of medical funds is a purse available for payment of said patient'"'"'s medical expenses.

61. The apparatus of claim 56, wherein said source of medical funds is a medical credit card account associated with said patient.

62. The apparatus of claim 56, wherein said processor circuitry is further configured to communicate with said source of medical funds about said patient encounter.

63. The apparatus of claim 62, wherein said processor circuitry is further configured to submit a claim for payment of said portion of said payment amount to be paid by said source of medical funds.

64. The apparatus of claim 62, wherein said processor circuitry is further configured to provide information that allows payment to be sent from said source of medical funds to said provider.

65. An apparatus for determining healthcare prices, the apparatus comprising:

processor circuitry configured to receive information entered about a patient encounter with a medical provider, wherein said information identifies a patient, said medical provider, and goods or services;

wherein said processor circuitry is further configured to determine a plurality of provider organizations that are affiliated with said medical provider;

wherein said processor circuitry is further configured to select at least one fee schedule associated with said patient encounter from amongst a hierarchy of fee schedules, by accessing a priority list that assigns a priority ranking to said fee schedules, wherein said selecting of said fee schedule is based on said priority ranking of fee schedules and based on said provider organizations that are affiliated with said medical provider;

wherein said processor circuitry is further configured to calculate said contracted payment amount associated with said encounter based on said selected fee schedule; and

wherein said processor circuitry is further configured to communicate said calculated contracted payment amount to at least said medical provider.

66. The apparatus of claim 65, wherein said processor circuitry is configured to calculate said contracted payment amount and to communicate said calculated payment amount to at least said medical provider in real time.

67. The apparatus of claim 65, wherein said processor circuitry is configured to calculate said contracted payment amount and to communicate said calculated payment amount to at least said medical provider while said patient waits with said medical provider.

68. The apparatus of claim 65, wherein said processor circuitry is further configured to select, from amongst said plurality of fee schedules, a fee schedule assigned a highest ranking in said priority list.

69. The apparatus of claim 65, wherein said processor circuitry is further configured to determine a portion of said payment amount to be paid by said patient and a portion of said payment amount to be paid from a source of medical funds.

70. The apparatus of claim 69, wherein said source of medical funds is a third-party payor.

71. The apparatus of claim 69, wherein said source of medical funds is a medical insurance company.

72. The apparatus of claim 69, wherein said source of medical funds is a Flexible Savings Account.

73. The apparatus of claim 69, wherein said source of medical funds is a purse available for payment of said patient'"'"'s medical expenses.

74. The apparatus of claim 69, wherein said source of medical funds is a medical credit card account associated with said patient.

75. The apparatus of claim 69, wherein said processor circuitry is further configured to communicate with said source of medical funds about said patient encounter.

76. The apparatus of claim 75, wherein said processor circuitry is further configured to submit a claim for payment of said portion of said payment amount to be paid by said source of medical funds.

77. The apparatus of claim 75, wherein said processor circuitry is further configured to provide information that allows payment to be send from said source of medical funds to said medical provider.

78. A system for determining healthcare prices, comprising:

interactive voice response means for receiving information entered about a patient encounter with a medical provider, wherein said interactive voice response means prompts a medical provider to enter patient identification information, medical provider identification information, and goods or services information and wherein said interactive voice response means receives said patient information, said medical provider information and said goods or services information;

means for selecting with a computer at least one fee schedule from amongst a hierarchy of fee schedules associated with said patient encounter based on a priority ranking of fee schedules by accessing a priority list that assigns a ranking to said fee schedules;

means for calculating a payment amount associated with said patient encounter based on said selected fee schedule; and

means for communicating said calculated payment amount to at least said medical provider.

79. The system of claim 78, further comprising means for communicating to a source of funds for medical expenses information about a portion of said payment amount to be paid from said source of funds.