Medical data analysis service

• US 8,527,292 B1
• Filed: 06/26/2006
• Issued: 09/03/2013
• Est. Priority Date: 07/01/2005
• Status: Expired due to Fees

• Current Assignee: Smartmc LLC
• Original Assignee: Smartmc LLC
• Inventors: Ozden, Banu R.
• Primary Examiner(s): Borlinghaus, Jason M
• Application Number:
  US11/475,652
• Time in Patent Office: 2,626 Days
• Field of Search: None
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/04 Billing or invoicing
• 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 70/60 relating to pathologies

Abstract

A medical data analysis service is provided. The service may be implemented as an on-line service using a data analysis server. The data analysis server may maintain patient databases and a community database. Each patient database may be populated with patient medical expense data such as medical bills from health care providers and insurance statements from insurance providers. The service analyzes the data in the databases to identify potential errors. The system detects errors in billing and insurance coverage and enables the patient to query medical expense data. The system enables patient'"'"'s notes relating to these services to be easily tracked, queried and shared. The system enables a patient to derive additional knowledge from the medical expense and insurance coverage data. This knowledge can be queried by the patient. The system enables a patient to derive more knowledge from collective patient medical expense and insurance coverage data and annotations.

Claims

1. A method for allowing a given patient to manage health care expenses using a computer-implemented medical expense data analysis service, comprising:

receiving health care provider statements from multiple health care providers and explanation of benefits documents from multiple insurance providers after patient responsibilities have been determined by the multiple health care providers and the multiple insurance providers;

with the computer-implemented medical expense data analysis service, checking medical expense data for the given patient that is associated with multiple insurance providers and multiple health care providers to detect billing and coverage errors, wherein the billing and coverage errors include mistakes and inconsistencies in the health care provider statements and the insurance provider explanation of benefits documents, and wherein checking the medical expense data comprises automatically discovering patterns and relationships in the medical expense data with data mining techniques;

maintaining at least one patient database containing the patient medical expense data and data on detected billing and coverage errors;

allowing the given patient to query the patient database; and

alerting the given patient to the identified billing and coverage errors.

2. The method defined in claim 1 further comprising:

with at least one data analysis server associated with the medical expense data analysis service, maintaining multiple patient databases that include medical expense data for multiple patients from multiple insurance providers and multiple health care providers;

at the data analysis server, analyzing the medical expense data for the multiple patients and multiple insurance providers and multiple health care providers in the patient databases to check for errors in the medical expense data of the given patient;

at the given patient, using a web browser to access the data analysis server over a communications network; and

using the web browser to provide the given patient with results from analyzing the medical expense data with the data analysis server that indicate whether the medical expense data of the given patient contains errors.

3. The method defined in claim 2 wherein the medical expense data comprises data from patient health care provider statements and insurance company explanation of benefits forms and wherein analyzing the medical expense data comprises analyzing the data from the health care provider statements and explanation of benefits forms.

4. The method defined in claim 3 wherein analyzing the data from the health care provider statements and explanation of benefits forms comprises determining whether there are deficiencies in coverage provided by any of the insurance providers for the given patient or whether there are errors in charges from any of the health care providers for the given patient.

5. The method defined in claim 2 wherein analyzing the medical expense data comprises:

analyzing data from external databases including a Medicare database.

6. The method defined in claim 2 wherein analyzing the medical expense data comprises:

analyzing data collected from multiple patients who use the medical expense data analysis service.

7. The method defined in claim 2 further comprising gathering medical expense data annotations from patients who use the medical expense data analysis service using the web browser and the data analysis server.

8. The method defined in claim 2 further comprising:

at the data analysis server, acquiring data that includes the medical expense data by acquiring the health care provider statements from the health care providers and the explanation of benefits forms from the insurance providers; and

building an index for maintaining the medical expense data at the data analysis server, wherein building the index comprises automatically extracting attributes from the health care provider statements and from the explanation of benefits forms and accepting manual data entry from patients.

9. The method defined in claim 8 further comprising:

at the data analysis server, extracting transactions from documents including the statements from health care providers and the explanation of benefits forms from insurance providers, wherein when a medical service appears in a plurality of the documents with changing attribute values, the data analysis server extracts the attribute values for the medical service from the documents and maintains a latest set of the extracted attribute values.

10. The method defined in claim 2 wherein the medical expense data comprises medical expense data obtained from documents that have been sent to patients as paper documents, documents that have been sent via email, and documents that are available online to download, the method further comprising:

scanning and uploading the paper documents to the data analysis server;

forwarding email documents to the data analysis server; and

at the data analysis server, directly downloading the documents that are available online.

11. The method defined in claim 10 further comprising:

at the data analysis server, extracting transactions from documents including the statements from health care providers and the explanation of benefits forms from insurance providers, wherein when a medical service appears in a plurality of the documents with changing attribute values, the data analysis server extracts the attribute values for the medical service from the documents and maintains a latest set of the extracted attribute values.

12. The method defined in claim 2 wherein the medical expense data includes medical services that appear on the health care provider statements, the method further comprising:

using the data analysis server to map medical services that appear on a given health care provider statement for the given patient with corresponding services appearing on multiple explanation of benefits documents from multiple insurance providers for the given patient.

13. The method defined in claim 2 wherein the medical expense data comprises medical expense data for related medical services and wherein the related medical services include medical services resulting from referrals, medical services that are follow-ups to previous medical services, and medical services that are a consequence of previous medical services, the method further comprising using the data analysis server to determine relationships between the related medical services using medical and billing coding standards.

21. The method defined in claim 1, further comprising:

with the computer-implemented medical expense data analysis service, checking medical expense data for a plurality of patients that are associated with multiple insurance providers and multiple health care providers to detect billing and coverage errors that are associated with each patient in a plurality of patients, wherein checking the medical expense data comprises automatically discovering patterns and relationships in the medical expense data with data mining techniques;

maintaining a plurality of patient databases, wherein each patient in the plurality of patients has an associated database in the plurality of databases that contains medical expense data and data on detected billing and coverage errors;

allowing each patient to query its associated patient database; and

alerting each patient to its associated identified billing and coverage errors.

22. The method defined in claim 21, further comprising:

anonymizing the medical expense data and the data on detected billing and coverage errors from each of the patient databases in the plurality of patient databases to produce anonymized medical expense data and anonymized data on detected billing and coverage errors;

maintaining the anonymized medical expense data and anonymized data on detected billing and coverage errors in a community database; and

allowing each patient in the plurality of patients to query the community database.

14. A method for allowing patients to obtain health care information using a computer-implemented medical expense data analysis service, comprising:

anonymizing and analyzing patient medical expense data of multiple patients from multiple insurance providers and multiple health care providers to produce anonymized and analyzed patient medical expense data;

with at least one data analysis server associated with the medical expense data analysis service, maintaining a searchable community database of the anonymized and analyzed patient medical expense data;

in response to a given patient of the multiple patients using a web browser to access the searchable community database at the data analysis server over a communications network, automatically comparing the medical expense data of the given patent with the medical expense data of other patients in the searchable community database; and

providing to the given patient results of the comparison of the medical expense data of the given patient with the medical expense data of the other patients in the searchable community database.

15. The method defined in claim 14 wherein anonymizing and analyzing the patient medical expense data at the data analysis server comprises using medical and billing coding standards to identify relationships in the patient medical expense data in which patients have used similar medical services and have had a similar diagnosis.

16. The method defined in claim 14 wherein anonymizing and analyzing the patient medical expense data at the data analysis server comprises using medical and billing coding to identify relationships in the patient medical expense data in which patients have used different medical services, had a different diagnosis, and have had different medical histories.

17. The method defined in claim 14 further comprising using the data analysis server to allow patients to share and search each other'"'"'s notes and annotations.

18. The method defined in claim 14 further comprising using the data analysis server to gather data for the searchable community database from external databases including Medicare databases.

19. The method defined in claim 14 further comprising:

using the data analysis server to gather data for the searchable community database from external databases including Medicare databases;

labeling data gathered for the searchable community database with labeling information based on its source; and

using the labeling information in evaluating the weight of data when analyzing the data and when presenting data to the given patient over the communications network.

20. A method for allowing a given patient to manage health care expenses using a computer-implemented medical expense data analysis service, comprising:

with at least one data analysis server associated with the medical expense data analysis service, maintaining multiple patient databases that include medical expense data for multiple patients from multiple insurance providers and multiple health care providers, wherein the multiple patients include the given patient;

at the data analysis server, analyzing the medical expense data for the multiple patients from multiple insurance providers and multiple health care providers from the multiple patient databases to check for errors in the medical expense data of the given patient, wherein analyzing the medical expense data comprises automatically discovering patterns and relationships in the medical expense data with data mining techniques;

at the given patient, using a web browser to access the data analysis server over a communications network;

using the web browser to provide the given patient with results from analyzing the medical expense data with the data analysis server that indicate whether the medical expense data of the given patient contains errors;

anonymizing and analyzing the medical expense data in the multiple patient databases for the multiple patients from multiple insurance providers and multiple health care providers to produce anonymized and analyzed patient medical expense data;

at the analysis server, maintaining a searchable community database of the anonymized and analyzed patient medical expense data;

in response to the given patient using a web browser to access the searchable community database at the data analysis server over a communications network, automatically comparing the medical expense data of the given patent with the medical expense data of other patients in the searchable community database.