Automated Medical Bill Negotiation System
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Solution Overview
Problem
Manual processes in data processing for cost and price determinations with electronic negotiation are inefficient, particularly in medical billing, where patients often face high bills without effective negotiation tools to reduce their balances.
Innovation Solution
A web-based automated bill negotiation system using a mobile app and remote server database that calculates settlement amounts, communicates with medical providers, and updates bill status, offering a service fee for accepted settlements, with algorithms to determine optimal discount offers based on patient billing information and provider pricing.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Productivity
If manual processes are used for data processing and bill negotiation, then patients can negotiate their bills, but the process is inefficient and time-consuming
Solution Approach 1:
The system enables automated bill negotiation where the computer executes instructions to calculate settlement amounts, generate offers, and negotiate with medical providers without requiring patient intervention. The patient simply provides initial billing information, and the system autonomously performs the entire negotiation process including calculating optimal settlement amounts based on patient financial information and provider pricing data.
Solution Approach 2:
The manual mechanical process of bill negotiation is replaced with an automated electronic system that uses computer-executable instructions to perform calculations, generate communications, and process negotiations. The system substitutes human manual efforts with automated computational processes that can rapidly analyze data and execute negotiation strategies.
2Productivity
If automated negotiation systems are implemented, then negotiation efficiency improves, but device complexity increases
Solution Approach 1:
The system is designed to handle multiple functions within a single integrated platform: storing patient and provider information, calculating settlement amounts, generating negotiation offers, communicating with providers, tracking negotiation status, and processing payments. This multi-functional approach consolidates what could be multiple separate systems into one unified solution.
Solution Approach 2:
The system acts as an intermediary between patients and medical providers, managing the complex negotiation process. It receives billing information from providers, processes it through automated calculations based on patient financial data, generates settlement offers, and communicates with providers on behalf of patients, thereby simplifying the interface for end users while handling complexity internally.
3Reliability
If settlement amounts are calculated and communicated to medical providers, then patient balances are reduced, but service fees are charged only on accepted settlements
Solution Approach 1:
The system incorporates feedback mechanisms where settlement offers are communicated to providers, who can accept or decline them. The system tracks the status of each negotiation and adjusts its strategy based on provider responses. This feedback loop allows the system to learn from acceptance patterns and optimize future negotiation approaches.
Solution Approach 2:
The system dynamically adjusts negotiation parameters such as settlement amounts, offer structures, and communication timing based on patient financial information, provider pricing data, and historical acceptance patterns. By changing these parameters adaptively, the system optimizes the likelihood of settlement acceptance while managing service fee collection effectively.
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.