Method and apparatus for assessing credit for healthcare patients

• US 8,452,611 B1
• Filed: 02/03/2010
• Issued: 05/28/2013
• Est. Priority Date: 09/01/2004
• Status: Active Grant

• Current Assignee: Search America Incorporated (Search)
• Original Assignee: Search America Incorporated (Search)
• Inventors: Johnson, Steven G., Busch, Christopher G.
• Primary Examiner(s): Le, Michelle
• Application Number:
  US12/699,789
• Time in Patent Office: 1,210 Days
• Field of Search: 705 2- 3, 705/36
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/03 Credit; Loans; Processing thereof

Abstract

According to one example embodiment, there is provided a method and an apparatus to evaluate the credit of a healthcare patient. The example embodiment provides methods and computer systems programmed to use multiple variables that are known about a patient prior to a service being rendered to segment the patient population into finer grained groupings. These finer grained groupings allow financial factors, such as a credit score, to be a more accurate predictor. Also, according to another example embodiment, the model is not a generic model for all patients, but the variables and their parameters are specific to a particular healthcare organization'"'"'s or facility'"'"'s patient population. This creates a custom model that further enhances its predictiveness.

Claims

1. A computerized method comprising:

obtaining initial patient information associated with one or more of a patient and a guarantor of costs, the costs associated with providing healthcare services to the patient;

determining a benefit of obtaining additional information including financial information related to the guarantor

weighing the benefit of obtaining the additional information against the cost of obtaining the additional information; and

determining whether to obtain the additional information at least in part based on the weighing, wherein the method is performed by a computing system comprising one or more computing devices.

2. The computerized method of claim 1, further comprising segmenting a patient population which includes the patient into categories at least in part based on one or more of the initial information or the additional information.

3. The computerized method of claim 2, further comprising segmenting the patient population into sub-categories at least in part based on one or more of the initial information or the additional guarantor financial information.

4. The computerized method of claim 2, further comprising assessing a service price for providing the healthcare services to the patient according to the determined patient category.

5. The computerized method of claim 1, wherein the initial information includes patient type, patient financial class, age, amount owed, and marital status.

6. The computerized method of claim 1, wherein the guarantor is other than the patient.

7. The computerized method of claim 1, wherein the additional information comprises a credit report of the guarantor obtained from a third party credit bureau.

8. The computerized method of claim 7, wherein the third-party source of guarantor financial information is selected from a group of third-party sources as a function of actual performance data.

9. A method comprising:

determining a probability that patient healthcare service charges will be paid as a function of one or more of patient information and guarantor financial information, wherein the probability is determined as a function of a payment probability model;

refining the payment probability model as a function of information including the determined probability and one or more of the patient information, the guarantor financial information, an indication of the source of the financial information, and received patient payment history associated with charges for the patient healthcare services, wherein the method is performed by a computing system comprising one or more computing devices.

10. The method of claim 9, wherein refining the payment probability model includes changing the source of financial information to determine the payment probability.

11. The method of claim 9, wherein the source of financial information is a credit bureau.

12. A method of selecting a source of financial information, the method comprising:

receiving first information related to one or more of a patient or a guarantor of costs associated with providing healthcare services to the patient;

receiving actual performance data of guarantor collection activity; and

selecting a source of financial information as a function of one or more of at least some of the first information and at least some of the actual performance data, wherein the method is performed by a computing system comprising one or more computing devices.

13. The method of selecting a source of financial information of claim 12, wherein at least some of the sources of financial information comprise respective credit bureaus.

14. The method of selecting a source of financial information of claim 12, wherein the actual performance data comprises one or more of data related to whether an attempt to contact a guarantor is successful or data related to whether payment is received on a guarantor account.

15. The method of selecting a source of financial information of claim 12, wherein the at least some of the first information comprises at least a portion of a guarantor zip code.

16. The method of selecting a source of financial information of claim 12, wherein the selecting comprises selecting a source of financial information based on at least the at least some of the first information and the at least some of the actual performance data.

17. The method of selecting a source of financial information of claim 12, wherein the at least some of the information includes geographic information related to the residence of one or more of the patient and the guarantor.

18. The method of selecting a source of financial information of claim 17, wherein the selecting is based at least in part on strengths of the sources of financial information in a region including the residence of one or more of the patient or the guarantor.

19. The method of selecting a source of financial information of claim 18, wherein the selecting comprises:

performing an initial ordering of the set of available sources of financial information based on the strengths; and

adjusting the initial ordering based on the actual performance data.

20. The method of selecting a source of financial information of claim 19, wherein the patient is the guarantor.