Patent Application
20070226006
This invention relates in general to medical information systems, and in particular to systems for clinics and doctor's offices.
In a doctor's office or a medical clinic, there is a need to gather patient information or update the information periodically. It is also desirable to obtain information on the method of payment that the patient will use. Often, presenting a card identifying the patient's insurer does this. Less often, the insurer is called to confirm the coverage.
The patient knows what his or her medical symptoms are but is less sure of costs related to curing his or her condition. The course of treatment is up to the doctor, but there is a need, from the patient's perspective, to understand what will be covered by insurance and what will be paid for out-of-pocket. Recent changes in insurance coverage and legislative modifications make this more and more difficult for the patient to make properly informed decisions. For those who have no medical coverage, the information on costs may by even more important.
Informational kiosks exist today (www.galvanon.com) that collect patient information at a hospital, clinic or office. These systems may link this information with practice management software (PMS) and electronic medical records (EMR). The insurers, like Blue Cross/Blue Shield, also have systems that allow doctor's to access their system for information about their patients, with the patient's permission. An example is shown in the following URL: (https://www.excellusbcbs.com/providers/index.shtml). Methods for identify checking of a patient are also well known in the art and include methods such as records with bar codes, multiple question/answer sequences, user name/password pairs, patient ID bracelets, RFID tags placed on the patient, etc.
There is an unmet need, however, to provide doctors and patients with a quick, automated, estimate of financial information—patient cost, provider payment, concerning a patient visit or procedure. This estimate may be based on a variety of information on different servers or websites.
Briefly, according to one aspect of the present invention a method for automatically determining the expected cost for a medical visit comprises: entering patient identification information; accessing the patient's medical records; entering a reason for the patient's visit, identifying the patient's health-care plan; and calculating an expected cost and payment for the medical visit.
The present invention is intended to provide the patient with a first and last contact point for a visit to a primary care physician (PCP) office or clinic. In addition, the invention estimates the payment that will be required as a result of this visit, relative to their coverage and out-of-pocket expenses.
The present invention is intended to be easily adaptable to the office/clinic where it is used, without requiring the intervention of highly trained and experienced staff for extended periods of time, by integrating with the existing PMS in the office or clinic.
a is a representation of the billing and privacy statement.
b is a representation of a Health Insurance Portability and Accountability Act (HIPAA) privacy statement.
The present invention will be directed in particular to a system for entering, modifying, and interpreting information from several sources to optimize business elements of a doctor's office of clinical check-in/check-out system. It is to be understood that elements not specifically shown or described may take various forms well known to those skilled in the art.
The system is intended to provide the patient with a first and last contact point for a visit to a PCP office or clinic. At check-in, the patient interacts with the system to establish identity, update/validate insurance information, patient demographic information, medical history, and purpose of visit. At this point, the system estimates the payment that the patient will be required to make.
The system is intended to be easily adaptable to the office/clinic where it is used, without requiring the intervention of highly trained and experienced staff for extended periods of time. Integration with any PMS is accomplished by means of creating a standard interface specifying a standard interface to the PMS, and creating custom code as required to access the PMS.
Referring now to
Patient identity establishment, at patient arrival 10, is the responsibility of the office/clinic. The check-in (kiosk) 15 assists in this identification 30 by allowing for the use of bar coded or magnetic stripe card or smart card media (or more, jump drive, web links, eye scan, etc.), to be created and/or supplied by the office/clinic, and used as an access control mechanism to the system. Examples are well known in the industry: (http://www.freescale.com/webapp/sps/site/application.jsp?nodeId=02430ZnQXG XDWd).
In addition to the information from those media, additional data entry and verification is required to establish reasonable identification (e.g. patient date of birth). Once the system accepts the verification sequence, the patient is allowed further into the system workflow process. Identity checks, as appropriate, are maintained throughout the balance of the flow. These are required because the patient, and so the check-in system, may access multiple different computer systems for relevant information, depending on the office/clinic computer system configuration and service provision.
Within the scope of the office/clinic, there is demographic information associated with the patient, including but not limited to, home address, phone number and other contact information. The demographic information is retained in the office/clinic PMS 12. That demographic information is subject to change from time to time.
Referring to
Generally, prior to the start of this process, the patient has made an appointment at the office/clinic, usually thru the office/clinic staff, providing some purpose of the visit 35. Should the appointment not have been made, or the reason not been recorded, the system responds appropriately by proceeding thru the sequence of questions/answers to create the appointment, and inquire as to the purpose of the visit.
Referring to
Referring to
The system requires the patient to validate appropriate services rendered payment capability, usually through health care insurance 50 coverage and an on-site co-pay. Referring to
The patient information is communicated to the health care payer 120 via computer systems connected by a network or Internet 110 connection.
Referring to
Those codes are translatable into financial characteristics, specific to health care payers and their contracts/coverages, including but not limited to: patient co-pay 150, prospective payment to office/clinic 140 to office/clinic, and any constraints on reimbursement.
One purpose of the system is to provide the patient with information regarding the expected cost to the patient of the upcoming procedures, and to provide the office/clinic staff with information regarding the patient payment mechanism.
The office/clinic 200 will generally, but not always, have billing relationships with more than one health care payer 215, 218, each of which will offer one or more coverage plans 220. This relationship is shown in
The office/clinic will make the decision to accept the health care payer payment 520. In the case where the office/clinic will bill the health care payer 280, 530, the office/clinic will accept the co-pay 265 from the patient, and subsequently bill the health care payer 270.
Some offices/clinics may refuse to bill health care payers 525, not accept health care payer payment 260, and require direct patient payment 285. The office/clinic will have a pricing list that details the charges to be made for the CPT codes that correspond to the visit. The system will use that pricing list to translate CPT codes to charges 570 for the visit. In this case, the office/clinic will bill the patient 275 the amount due. Information about health care payer coverage is still of value to the practice, for the purposes of: establishing an understanding of community pricing levels; determining areas where premium pricing over community levels may be justified; demonstrating the economic viability of the office/clinic to external parties. It is of course possible that offices/clinics that do not have billing/paying relationships with specific health care payers will not be allowed access to that specific information.
Regardless of the sources of information, there is sufficient data present to build up patient expected charges 580, and present the expected costs of the visit.
Referring to
Referring to
After check-in, the patient proceeds with the encounter 20, and participates in the procedures/tests/purposes of the visit. There is always the possibility that the initially provided visit reason does not describe the actual encounter, or additional procedures were performed, or other non-anticipated activity took place, which will impact the cost to the patient and/or payments to the office/clinic. The staff of the office/clinic must assure that the system has access to the actual procedures which took place, in order to assure that cost and billing information is available to the patient prior to leaving the office/clinic.
At check-out 25, the patients is enabled to view the actual charges 55 relevant to the visit 600, shown in
The invention has been described in detail with particular reference to certain preferred embodiments thereof, but it will be understood that variations and modifications can be effected within the scope of the invention.
