Medical payment system

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. 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.

1 . A computer system of facilitating payment of health care benefits comprising:
 healthcare provider identification information;   storing a plurality of fee schedules in computer memory;   electronically receiving data about a healthcare expense associated with a healthcare provider and a patient; and   computer hardware configured to:
 identify a payer that has agreed to pay the healthcare provider on behalf of the patient; 
 identify one of the plurality of fee schedules that should be used in association with the healthcare expense based on eligibility, and priority in order to identify the healthcare provider's highest-priority payer affiliation; 
 calculate a payment amount based at least in part on a fee schedule; 
 electronically verify that the payment amount is a bona fide medical expense; 
 approve the payment amount only when the payment amount has been verified; and 
 electronically transfer the verification of the payment amount to an account associated with the patient; and 
 electronically transmit a copy of the payment amount to the healthcare provider. 
   
     
     
         2 . The system of  claim 1  wherein the account is a bank account. 
     
     
         3 . The system of  claim 2  wherein the bank account is associated with a card that is at least one of the group consisting of: a stored value card, a medical credit card, and a medical plan card. 
     
     
         4 . The system of  claim 1  wherein the computer hardware is further configured to approve multiple payment amounts. 
     
     
         5 . The system of  claim 1  wherein the computer hardware is further configured to receive and store multiple payment amounts. 
     
     
         6 . The system of  claim 1  wherein the computer hardware is further configured to process and store multiple payment amounts associated with multiple patient encounters. 
     
     
         7 . The system of  claim 1  further comprising an interactive voice response system configured to prompt the healthcare provider to enter information about a patient encounter. 
     
     
         8 . The system of  claim 1  further comprising an interactive voice response system configured to communicate information about the approval of the payment amount. 
     
     
         9 . The system of  claim 1  further comprising an interactive voice response system configured to communicate information about the account. 
     
     
         10 . The system of  claim 1  wherein the computer hardware is further configured to determine a portion of the payment amount to be paid by the patient and a portion of the payment amount to be paid from a source of medical funds. 
     
     
         11 . The system of  claim 10 , wherein the source of medical funds is a third-party payor. 
     
     
         12 . The system of  claim 10 , wherein the source of medical funds is a flexible savings account. 
     
     
         13 . A method of facilitating payment of health care benefits to a health care provider comprising:
 storing a plurality of fee schedules in computer memory;   electronically receiving data about a healthcare expense associated with a healthcare provider and a patient, wherein the healthcare provider renders goods and services to the patient in anticipation of payment;   identify one of the plurality of fee schedules that should be used in association with the healthcare expense based on eligibility, and priority in order to identify the healthcare provider's highest-priority payer affiliation;   determining with computer hardware, a payment amount associated with the goods or services wherein determining the payment amount comprises calculating the payment amount based at least in part on the identified schedule;   electronically verifying with computer hardware that the payment amount is a bona fide medical expense;   determining with computer hardware a first portion of the payment amount to be paid by the patient and a second portion of the payment amount to be paid from a source of medical funds;   electronically sending the verification of the payment amount to an account associated with the patient;   electronically approving, the payment amount only when the verification of the payment amount has been received; and   communicating to the patient the first portion of the payment amount paid by the patient and the second portion of the payment paid by the one or more insurance providers.   
     
     
         14 . The method of  claim 13  wherein the account is a bank account. 
     
     
         15 . The method of  claim 13  wherein the bank account is associated with a card that is at least one of the group consisting of: a stored value card, a medical credit card, and a medical plan card. 
     
     
         16 . The method of  claim 13  further comprising approving multiple payment amounts. 
     
     
         17 . The method of  claim 13  further comprising receiving and storing multiple payment amounts. 
     
     
         18 . The method of  claim 13  further comprising processing and storing multiple payment amounts associated with multiple patient encounters. 
     
     
         19 . The method of  claim 13  further comprising prompting a provider with an interactive voice response system to enter information about a patient encounter. 
     
     
         20 . The method of  claim 13 , wherein the source of medical funds is a third-party payor. 
     
     
         21 . The method of  claim 13 , wherein the source of medical funds is a flexible savings account.