Patient Responsibility Payment Authorization System
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Solution Overview
Problem
The increasing burden on healthcare service providers to collect patient responsibilities for healthcare services, exacerbated by rising copayments and deductibles, leads to complex and costly collection processes, and potential financial hardships for patients, while upfront collection methods face legal challenges and administrative difficulties.
Innovation Solution
A method that involves estimating patient responsibility for healthcare services, obtaining payment authorization, and processing payments or refunds after services are rendered, using a computer-readable medium to automate the process and reduce transaction costs and administrative burdens.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Productivity
If upfront collection of patient responsibility is implemented, then collection efficiency is improved, but legal risks and administrative complexity increase
Solution Approach 1:
The system performs preliminary actions by obtaining patient payment authorization before services are rendered. This allows the healthcare provider to securely collect payment after services are provided, avoiding the legal and administrative issues associated with upfront collections while maintaining collection efficiency. The authorization is obtained during the scheduling or registration phase, enabling seamless post-service payment processing.
Solution Approach 2:
The system introduces an intermediary mechanism - a payment authorization system that acts as a mediator between the patient and the healthcare provider. This intermediary layer resolves the contradiction by providing a legally compliant framework that enables efficient collection without the harmful effects of direct upfront charging. The authorization serves as a bridge that allows post-service collection while protecting both patient and provider interests.
2Reliability
If traditional post-service collection methods are used, then legal and administrative issues are minimized, but collection time and transaction costs increase
Solution Approach 1:
The system performs the legal compliance action in advance by obtaining payment authorization before services are rendered. This preliminary authorization enables the system to process payments quickly after services are provided, eliminating the time-consuming post-service collection process while maintaining full legal compliance. The authorization is secured during scheduling or registration, allowing immediate payment processing upon service completion.
Solution Approach 2:
The system replaces the traditional mechanical collection process (manual billing, statements, and payment processing) with an automated electronic system. The payment authorization is stored and processed electronically, substituting the time-consuming manual mechanics of traditional collection with an efficient automated process that maintains legal compliance while dramatically reducing collection time.
3Reliability
If estimated cost collection is implemented before services, then patient responsibility is secured, but conflicts with not-for-profit missions and quality care priorities arise
Solution Approach 1:
The system performs preliminary action by obtaining payment authorization before services are rendered, but does not charge the patient until after services are provided and actual costs are determined. This approach secures payment reliability while maintaining alignment with not-for-profit missions, as the authorization is obtained during scheduling or registration without creating financial hardship or conflicting with quality care priorities.
Solution Approach 2:
The system applies partial action by obtaining authorization for an estimated amount before services, but only charging the actual amount after services are provided. This partial approach to upfront collection secures payment reliability while avoiding the excessive action of charging full estimated amounts before services, thereby maintaining mission alignment and avoiding conflicts with not-for-profit priorities.
4Productivity
If multiple collection attempts are made after services, then complete payment is achieved, but patient hardship and administrative burden increase
Solution Approach 1:
The system performs preliminary action by obtaining payment authorization before services are rendered, which eliminates the need for multiple post-service collection attempts. The single upfront authorization secures payment completion while avoiding the harmful effects of repeated collection efforts, such as patient hardship and increased administrative burden. Payment is processed once after services based on the pre-obtained authorization.
Data Source
AI summary
A method is provided for obtaining payment for services provided to a patient by a healthcare service provider. The method includes receiving a description (203) of the healthcare services to be provided to the patient by the healthcare service provider; obtaining a cost estimate (205) for the patient responsibility portion of the cost of the healthcare services; and receiving payment authorization (207) from the patient in the amount of the cost estimate along with the payment method information. The payment authorization includes authorization to withdraw funds in the estimated amount from an account associated with the patient. After the healthcare services have been provided to the patient or after all claims relating to the healthcare services have been adjudicated, funds are withdrawn (215) from the account in the authorized amount.