Method for determining eligibility for an assistance program
View Patent ↗A system for determining a patient benefits eligibility under a healthcare assistance program. Initial patient information, such as the patient's date of birth, household members, medical condition including pregnancy, and income and financial resources, if available, is used to make an initial determination as to whether the patient is likely to qualify for benefits. If the initial patient information satisfies one of the well-established criteria or the probability models, additional patient information is obtained, typically including additional details about the patient's income and financial resources, as well as the income and financial resources of the patient's household. The patient information is compared to the eligibility requirements for the assistance program. If the comparison indicates that it is likely that the patient will qualify for benefits under the assistance program, then an application for the assistance program is provided and the application is completed and submitted.
1. A computer-implemented method for identifying and applying for benefits for a patient, comprising the steps of:
receiving a referral from a medical facility for a patient and receiving initial patient information, at at least one of a workstation and a server;
based on the initial patient information, the at least one of the workstation and the server making an initial determination as to whether it is likely that benefits can be obtained for the patient under an assistance program;
if the initial determination is that it is unlikely that benefits can be obtained then rejecting the referral;
if the initial determination is that it is likely that benefits can be obtained for the patient, then receiving additional patient information, at the at least one of the workstation and the server;
based on the additional patient information, the at least one of the workstation and the server making a second determination as to whether it is likely that benefits can be obtained for the patient under the assistance program;
if the second determination is that it is likely that benefits can be obtained, then the at least one of the workstation and the server providing an application for the assistance program; and
the at least one of the workstation and the server undertaking to perform at least one of submitting a completed application to the assistance program and providing a copy of the completed application for submission to the assistance program.
2. The method of claim 1 , wherein the step of receiving the initial patient information includes receiving information about the patient's age and medical condition.
3. The method of claim 1 , wherein the step of receiving the initial patient information includes receiving information about the patient's income and financial resources.
4. The method of claim 1 , wherein the at least one of the workstation and the server making the initial determination as to whether it is likely that benefits can be obtained for the patient under an assistance program, comprises:
the at least one of the workstation and the server comparing the initial patient information to a well-established criteria for the assistance program.
5. The method of claim 4 , wherein the at least one of the workstation and the server comparing the initial patient information to the well-established criteria for the assistance program includes comparing the initial patient information to well-established criteria that is based upon a court decision.
6. The method of claim 4 , wherein the at least one of the workstation and the server comparing the initial patient information to the well-established criteria for the assistance program includes comparing the initial patient information to well-established criteria that is based upon an agency decision.
7. The method of claim 1 , wherein the at least one of the workstation and the server making the initial determination as to whether it is likely that benefits can be obtained for the patient under an assistance program, comprises:
the at least one of the workstation and the server comparing the initial patient information to a probability model.
8. The method of claim 7 , wherein the at least one of the workstation and the server comparing the initial patient information to a probability model includes comparing the initial patient information to a probability model that is based upon prior experience in obtaining benefits under the assistance program for a plurality of patients.
9. The method of claim 1 , wherein the step of receiving the additional patient information includes receiving a discharge diagnosis.
10. The method of claim 1 , wherein the at least one of the workstation and the server providing the application for the assistance program comprises:
the at least one of the workstation and the server providing prompts to assist in completion of the application.
11. The method of claim 1 , further comprising:
the at least one of the workstation and the server determining whether the patient is already covered by an assistance program.
12. The method of claim 1 , further comprising:
the at least one of the workstation and the server determining whether the patient has previously submitted a first application for a first assistance program;
if the patient has previously submitted a first application for a first assistance program, then the at least one of the workstation and the server determining the status of the first application; and
if the status of the first application is pending, then the at least one of the workstation and the server providing an update for the first application.
13. A computer-implemented method for accepting a patient referral for Medicaid, comprising the steps of:
receiving a patient referral at at least one of a workstation and a server, the patient referral including initial patient information;
the at least one of the workstation and the server determining whether to accept the patient referral by: comparing the initial patient information to a well-established criteria associated with a Medicaid first assistance program;
if the comparison indicates that the initial patient information satisfies the well-established criteria, then accepting the patient referral;
if the patient referral is accepted, then receiving additional patient information, at the at least one of the workstation and the server;
the at least one of the workstation and the server comparing the initial patient information and the additional patient information to eligibility requirements for the Medicaid first assistance program; and
if the comparison indicates it is likely that benefits can be obtained under the Medicaid first assistance program, then the at least one of the workstation and the server providing an application for the Medicaid first assistance program.
14. The method of claim 13 , wherein the at least one of the workstation and the server determining whether to accept the patient referral further comprises:
the at least one of the workstation and the server comparing the initial patient information to a probability model associated with a second assistance program;
if the comparison indicates that the initial patient information satisfies the probability model, then accepting the patient referral.
15. The method of claim 14 , wherein the at least one of the workstation and the server comparing the initial patient information to the probability model associated with the second assistance program includes comparing the initial patient information to a probability model that is based upon prior experience in obtaining benefits under the second assistance program for a plurality of patients.
16. The method of claim 14 , wherein the at least one of the workstation and the server comparing the initial patient information to the probability model associated with the second assistance program includes comparing the initial patient information to a probability model that is modified based upon actual experience in obtaining benefits under the second assistance program.
17. The method of claim 13 , wherein the at least one of the workstation and the server providing the application for the first assistance program, comprises:
the at least one of the workstation and the server providing prompts during completion of the application to ensure the application is answered consistently.
18. The method of claim 13 , wherein the at least one of the workstation and the server providing the application for the first assistance program, comprises:
the at least one of the workstation and the server automatically completing a section of the application using the initial patient information.
19. The method of claim 13 , wherein the steps of receiving and accepting the patient referral include receiving and accepting the patient referral by an entity that is independent of a medical provider providing treatment to the patient.
20. The method of claim 19 , wherein the step of accepting the patient referral, further comprises a step of determining if payment is provided to a medical provider providing treatment to the patient by the assistance program, and if so then paying the entity a portion of the payment from the medical provider.
21. The method of claim 13 , further comprising:
the at least one of the workstation and the server submitting the application; and
the at least one of the workstation and the server monitoring the application.
22. The method of claim 13 wherein the step of comparing the initial patient information to the well-established criteria associated with the Medicaid first assistance program includes analyzing the patient's disability status.
23. The method of claim 13 wherein the step of comparing the initial patient information to the well-established criteria associated with the Medicaid first assistance program includes analyzing the patient's indigence status.
24. A computer-implemented method for selecting an assistance program for a patient, comprising the steps of:
receiving initial patient information, at at least one of a workstation and a server;
based on the initial patient information, the at least one of the workstation and the server making an initial determination as to whether it is likely that benefits can be obtained for the patient under an assistance program by:
the at least one of the workstation and the server comparing the initial patient information to a well-defined criteria corresponding to a first assistance program;
if the initial patient information satisfies the well-defined criteria, then the at least one of the workstation and the server identifying the first assistance program;
the at least one of the workstation and the server comparing the initial patient information to a probability model corresponding to a second assistance program;
if the initial patient information satisfies the probability model, then the at least one of the workstation and the server identifying the second assistance program;
if the initial determination is that it is likely that benefits can be obtained, then receiving additional patient information, at the at least one of the workstation and the server;
the at least one of the workstation and the server making a subsequent determination as to whether it is likely that benefits can be obtained for the patient by comparing the initial patient information and the additional patient information to the first and second identified assistance programs that are identified; and
if the subsequent determination is that it is likely that benefits can be obtained for the patient, then selecting the identified assistance program.
25. The method of claim 24 , further comprising:
the at least one of the workstation and the server identifying an application for the selected assistance program; and
the at least one of the workstation and the server providing prompts to assist in the completion of the application, the prompts identifying related questions.
26. The method of claim 24 , wherein the step of receiving the initial patient information includes receiving an age and a medical condition.
27. The method of claim 24 , wherein the step of receiving additional patient information includes receiving income and financial resource information for member's of the patient's household.
28. The method of claim 24 , wherein the at least one of the workstation and the server comparing the initial patient information to the well-defined criteria corresponding to the first assistance program includes comparing the initial patient information to well-defined criteria that is based upon a judicial determination of eligibility under the first assistance program.
29. The method of claim 24 , wherein the at least one of the workstation and the server comparing the initial patient information to the probability model corresponding to the second assistance program includes comparing the initial patient information to a probability model that is based upon prior experience in obtaining benefits under the second assistance program for a plurality of patients.
30. The method of claim 29 , further comprising:
adjusting the probability model based upon common characteristics shared by a plurality of patients that did not receive benefits under the second assistance program.