Method and system for insurance companies contracting with and paying medical image reading professionals in a network

• US 8,224,675 B2
• Filed: 02/04/2009
• Issued: 07/17/2012
• Est. Priority Date: 02/08/2008
• Status: Expired due to Fees

• Current Assignee: Premerus LLC
• Original Assignee: Premerus LLC
• Inventors: Thorne, Curtis J., Allen, Gregg Phillip
• Primary Examiner(s): KOPPIKAR, VIVEK D
• Application Number:
  US12/365,815
• Publication Number:
  US 20090204445A1
• Time in Patent Office: 1,259 Days
• Field of Search: 705 2- 3, 600300-301
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/06398 Performance of employee with respect to a job function
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms

Abstract

A system and method for insurance companies contracting with and paying medical image reading professionals in a medical image reading professionals network. The network may be independent of a medical facility and be arranged to have each of the medical image reading professionals may be an expert in reading medical images of particular anatomical regions. The insurance companies may have lower overall costs by contracting with the medical image reading professionals who are experts in reading medical images of anatomical regions, modalities, and medical conditions as misdiagnoses are reduced due to proficiency of the medical image reading professionals.

Claims

1. A method for an insurance company to contract with medical image reading professionals, said method comprising:

receiving, by a computing system of the insurance company, an application of a medical image reading professional who, to perform medical duties, receives medical information from a medical professional network manager and who has qualified to participate in a network of medical image reading professionals that the medical professional network manager manages, the medical image reading professional being identified as an expert in reading medical images of one or more anatomical regions, the medical professional network manager further having an agreement with the insurance company to identify to the insurance company an anatomical region captured in medical images read by medical image reading professionals in the network of medical image reading professionals;

verifying, by the computing system, that the medical image reading professional is a member of the network of medical image reading professionals;

approving, by the computing system, the application of the medical image reading professional in response to positively verifying that the medical image reading professional is a member of the network;

establishing, by the computing system, the medical image reading professional as a payee in performing medical services;

in response to the insurance company receiving a claim for payment to the medical image reading professional for reading a medical image of an identified anatomical region, verifying that the medical image reading professional is an expert in reading medical images of the identified anatomical region;

making payment of the claim if the medical image reading professional is verified to be an expert in reading medical images of the identified anatomical region; and

otherwise, denying payment on the claim.

2. The method according to claim 1, wherein receiving the application includes receiving the application from the medical image reading professional.

3. The method according to claim 1, wherein receiving the application includes receiving an area of expertise in which the medical image reading professional practices.

4. The method according to claim 1, wherein the medical professional network manager is independent of medical care facilities.

5. The method according to claim 1, further comprising:

evaluating the medical professional network manager; and

approving the medical professional network manager as an authorized service provider such that medical image reading professionals associated with the medical professional network manager are able to submit applications.

6. A system for paying medical image reading professionals, said system comprising:

a storage unit configured to store information; and

a processing unit in communication with said storage unit, and configured to execute;

a first module configured to recognize a network of medical image reading professionals who interpret medical information of patients to qualify for medical insurance payment reimbursement, each medical image reading professional in the network managed by a medical professional network manager having at least one rating parameter associated therewith indicative of outcome of patients who were treated based on assessments of medical conditions by a respective medical image reading professional, each of the medical image reading professionals being identified as an expert in reading medical images of one or more anatomical regions, the medical professional network manager further having an agreement with an insurance company to provide an identification of an anatomical region captured in medical images read by the medical image reading professionals in the network of medical image reading professionals, information representative of each medical image reading professional and the at least one rating parameter being stored in said storage; and

a second module in communication with said first module, and configured to process insurance payment requests presented to the insurance company for the medical image reading professionals, the processing of the insurance payment requests including verifying that the medical image reading professional is an expert in reading medical images of the identified anatomical region; and

a third module configured to (i) cause payment to be made to the medical image reading professional in the network in response to verifying that the medical image reading professional is an expert in reading medical images of the identified anatomical region or (ii) cause payment to be denied.

7. The system according to claim 6, further comprising:

a fourth module configured to process an application of a medical image reading professional to become a payee of the insurance company; and

a fifth module configured to establish the medical image reading professional as a payee.

8. The system according to claim 6, where said first and second modules are executed on a first server configured to communicate with a second server that maintains records of medical image reading professionals in the network of medical image reading professionals.

9. A method for paying medical image reading professionals, said method comprising:

recognizing, by a computing system, a network of medical image reading professionals who interpret medical information of patients to qualify for medical insurance payment reimbursement, each medical image reading professional in the network having at least one rating parameter associated therewith indicative of outcome of patients who were treated based on assessments of medical conditions by the respective medical image reading professional, each medical image reading professional being identified as an expert in reading medical images of one or more anatomical regions, the medical professional network manager of the medical image reading professionals network further having an agreement with an insurance company to provide an insurance company with an identification of an anatomical region captured in medical images read by the medical image reading professionals in the network of medical image reading professionals;

receiving, by the insurance company, an identification of the anatomical region captured in a medical image read by a medical image reading professional;

in response to verifying that the medical image reading professional who performed the reading of the medical images is an expert in reading medical images of the identified anatomical region by the insurance company, paying the medical image reading professional in the network of medical image reading professionals for reading the medical image of an anatomical region; and

otherwise, denying payment to the medical image reading professional.

10. The method according to claim 9, further comprising paying referring medical professionals who refer the patients to a medical image reading professional in the network of medical image reading professionals.

11. The method according to claim 10, wherein paying the referring medical professionals includes paying the referring medical professionals different from referring medical professionals who refer the patients to a medical image reading professional not in the network of medical image reading professionals.

12. The method according to claim 9, wherein recognizing a network of medical image reading professionals includes recognizing a network of medical image reading professionals who are experts in reading medical images of anatomical regions as a result of reading a certain minimum number of medical images of the identified anatomical regions over a given time frame.

13. A method of paying medical image reading professionals for performing services, said method comprising:

receiving, by the computing system, a medical insurance claim for medical services having been performed on a patient with a medical condition of an anatomical region, the medical insurance claim indicating medical image reading services having been rendered by a medical image reading professional;

receiving, by the computing system, an identification of a medical image reading professional who performed the medical image reading services, the medical image reading professional being identified as an expert in reading medical images of the anatomical region;

confirming, by the computing system, that the medical image reading professional is an expert in reading medical images of the anatomical region of which the patient has a medical condition, and, pursuant to an agreement between an insurance company and medical professional network manager, an identification of the anatomical region of the medical images being provided to the insurance company for the confirmation;

receiving, by the insurance company, an identification of the anatomical region captured in a medical image read by a medical image reading professional;

in response to verifying that the medical image reading professional is an expert in reading medical images of the identified anatomical region, paying the medical image reading professional for performing the medical image reading services; and

otherwise, not paying the medical image reading professional.

14. The method according to claim 13, wherein the medical image reading professional is in a network of medical image reading professionals that is independent of a medical facility.

15. The method according to claim 14, further comprising:

receiving a medical claim for medical service from a treating physician, the treating physician having referred the patient to a medical image reading professional outside the network; and

paying the treating physician a different amount than had the treating physician referred the patient to the medical image reading professional in the network of medical image reading professionals.