Data processing: financial – business practice – management – or co – Automated electrical financial or business practice or... – Insurance
Reexamination Certificate
2003-05-22
2004-11-30
Thomas, Joseph (Department: 3626)
Data processing: financial, business practice, management, or co
Automated electrical financial or business practice or...
Insurance
C705S002000
Reexamination Certificate
active
06826537
ABSTRACT:
BACKGROUND
1. Field of Invention
Embodiments of the invention relate to reducing fraud in government healthcare programs that tracks identification, implements security measures, and other information to facilitate the transfer of funds and eliminate fraud in the benefit.
2. Description of Related Art
Providers of benefits from government sponsored healthcare providers have concerns wherein individuals can “double dip” into government sponsored healthcare provider programs getting twice the payment, or service providers could inadvertently “double bill” or inappropriately bill for services rendered.
In addition, problems have existed wherein proper service and goods providers for government healthcare programs have had to wait long periods of time to get paid for their services or goods rendered to the eligible employee. This situation has caused benefit costs to be very high, reducing overall benefits available due to these fraud issues.
A need has long existed for a system wherein the government sponsored healthcare provider advances funds to pay a service or goods provider so that an eligible individual does not have to handle money and the provider is promptly paid.
This need has been particularly great for incapacitated individuals such as those in nursing homes who are no longer able to handle funds or complicated transactions themselves.
A need exists for a method to reduce the magnitude of transaction costs involved in reviewing and adjudicating payment requests to a government sponsored healthcare provider that would have the effect of reducing the rate of increase of government sponsored healthcare provider benefit costs or enable more benefits to be provided to more people.
A need exists to reduce the traditionally high cost of benefit administration, including the review and adjudication of payment requests that result in service, goods or benefit providers having to act as “banks” or “credit sources” for individuals eligible for the benefit.
Methods and apparatus exist to streamline private sponsored insurance claim payment process, such as the method disclosed in U.S. Pat. No. 6,163,770. This patent reveals using a digital electrical apparatus to generate output for insurance documentation for a first insurance policy having a first risk and claims and reveal a concurrent second insurance policy for a second risk, wherein the second risk is different from the first. The processor of this method is connected to a memory device for storing and retrieving operations including machine-readable signals in the memory device, to an input device for receiving input data and converting the input data into input electrical data, to a visual display unit for converting output electrical data into output having a visual presentation, to a printer for converting the output electrical data into printed documentation, wherein the processor is programmed to control the apparatus to receive the input data and to produce the output data by steps including: inputting actuarial assumptions defining the first insurance policy and computing a value of a specific financial attribute of the first insurance policy; the method further including the step of inserting the value of the financial attribute in the first insurance policy and other printed documentation related to the first insurance policy. This method does not meet the needs identified above.
SUMMARY OF THE INVENTION
The present invention provides a cardless method for reducing fraud in government healthcare programs.
The method involves registering a service or goods provider with a government sponsored healthcare provider and issuing a service provider identification code to that provider. Services and goods of the provider can be registered with a healthcare provider and claim codes would correspond with each registered service. The healthcare provider can include a physician.
The method involves using a form of identification, such as fingerprints or retinal reading for individuals eligible for a government healthcare program. In addition to the biometrics reading, data from a keypad entry with a “PIN” code, or an electronic signature pad entry can be performed. The method involves a first identification check and then three transmissions between the service provider to the healthcare provider about proposed goods and services, information about the individual, and information about payment for the provider.
The invention is a method for reducing fraud in a government healthcare program. The method entails registering a service provider with a healthcare provider and issuing a service provider identification code and registering at least one service or at least one good of the service provider with the healthcare provider and identifying a claim code for each registered service or registered good.
The method involves three transmissions: a first transmission from the service provider to the healthcare provider (which includes the service provider identification code) the individual identification code, proposed product information for the individual, and proposed service information for the individual. The first transmission also contains corresponding claim codes for the proposed product, corresponding claim codes for the proposed service, a request to confirm the individual's eligibility for benefits under the government healthcare program, a validation that the proposed good or service is approved for the individual, the service provider's eligibility to render services or provide goods under the healthcare program, and a request to participate in an accelerated payment program for the proposed good or the proposed service.
The second transmission from the government sponsored healthcare provider to the service provider, wherein the second transmission comprises of: the individual's eligibility for benefits under the healthcare program; a validation that the proposed good or proposed service is approved for the individual; a validation of the service provider's eligibility to render services under the healthcare program; a confirmation that a payment program is available; and an authorization code to provide the proposed product and/or proposed service.
A third transmission is from the service provider to the government sponsored healthcare provider, and comprises of a list of claim codes for services rendered; acknowledgement by the individual that information on the product and/or service was provided to the individual; acknowledgement that the product or service has been received from the service provider; and a request for accelerated payment by the healthcare provider to the service provider.
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Eiland, “A Bill to be Entitled an Act.” Acts of the 75thLegislature, Regular Session, 1997.
Ogden, “A Bill to be Entitled an Act.” Acts of the 78thLegislature, Regular Session, 2003.
“Texas Senate Special Committee on Prompt Payment of Health Care Providers.” Interim Report to the 78thLegislature, Nov. 2002.
Rehnquist, Janet. “Improper Fiscal Year 2002 Medicare Fee-for-Service Payments,” Jan. 8, 2003 (A17-02-02202).
White, Jr. Wesley Jack
Wood Richard Glee
Buskop Wendy
Buskop Law Group P.C.
Gilligan Christopher L
Thomas Joseph
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