Automated Medical Bill Negotiation System
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Solution Overview
Problem
Existing data processing systems for cost and price determinations in medical billing often rely on manual processes, which are inefficient and prone to errors, especially in electronic negotiations between patients and medical providers.
Innovation Solution
A data processing system configured with an electronic negotiation mobile app, utilizing a remote server database and processor, that automates the calculation and negotiation of settlement amounts for medical bills, facilitating electronic communication with medical providers and updating bill statuses accordingly.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Productivity
If manual processes are used for data processing in medical billing negotiations, then flexibility and human judgment are maintained, but efficiency is reduced and errors increase
Solution Approach 1:
The system enables automated self-service negotiation between patients and providers through electronic messaging. The negotiation process occurs automatically without requiring manual intervention from billing specialists, with the system independently exchanging offers, counteroffers, and settlement proposals between parties based on pre-configured rules and algorithms.
Solution Approach 2:
Manual mechanical negotiation processes are replaced with an automated electronic system that uses computer algorithms to perform data processing, calculation, and communication. The system substitutes human operators with automated software that executes negotiation protocols, calculates settlement amounts, and manages the entire billing negotiation workflow electronically.
2Productivity
If manual data processing is used for setup, then system complexity is reduced, but productivity and efficiency deteriorate
Solution Approach 1:
The automated negotiation system performs multiple functions within a single integrated platform: data processing, negotiation management, electronic messaging, settlement calculation, and documentation. This multi-functional system handles the entire billing negotiation lifecycle without requiring separate manual processes for each task, thereby increasing productivity despite the inherent complexity of automation.
3Ease of operation
If automated negotiation systems are implemented, then productivity and efficiency improve, but device complexity increases
Solution Approach 1:
The system introduces an automated electronic intermediary that mediates negotiations between patients and providers. This intermediary automatically manages the complex communication protocols, calculates settlement amounts based on predefined criteria, and coordinates the negotiation process, thereby simplifying the user experience while handling the underlying system complexity automatically.
Data Source
AI summary
The embodiments disclose a data processing cost and price determination platform with electronic negotiation, including a mobile app configured to register a medical patient, a medical database configured to retrieve patient demographics, patient medical necessity codes and patient billed account data related to the medical patient of a medical provider, a server configured to electronically collect updated patient medical pricing data from governmental and health insurance carrier sources and medical necessity standards based on demographics of the medical provider, a processor configured to compare the patient billed account with the updated medical pricing data to determine a suggested fair market of the patient billed account, an electronic negotiation module to submit the suggested fair market of the patient billed account data to the medical provider for soliciting a negotiated settlement rate and a communication module to transmit the accepted negotiated settlement rate from the medical provider to the medical patient.