Method and apparatus for assessing credit for healthcare patients

• US 7,904,306 B2
• Filed: 09/01/2005
• Issued: 03/08/2011
• 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): Frenel; Vanel
• Application Number:
  US11/218,069
• Publication Number:
  US 20060111940A1
• Time in Patent Office: 2,014 Days
• Field of Search: 705 2- 3, 705/36, 705/38
• 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 to make healthcare patient credit decisions comprising:

receiving patient information;

obtaining financial information from a guarantor of costs associated with services the patient needs;

determining a benefit of additional guarantor financial information from a third party; and

obtaining the additional guarantor financial information from the third party if the benefit of the additional guarantor financial information is greater than the cost of obtaining the additional information, 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 the patient population into categories.

3. The computerized method of claim 2, further comprising:

segmenting the patient population into sub-categories.

4. The computerized method of claim 2, further comprising:

assessing a service price according to the determined patient category.

5. The computerized method of claim 1, wherein the patient 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 third party is a credit bureau.

8. The computerized method of claim 1, wherein the financial information includes guarantor credit information.

9. The computerized method of claim 1, wherein an assessed service cost is a discounted service cost.

10. The computerized method of claim 1, wherein patient categories are defined according to healthcare facility defined rules.

11. The computerized method of claim 1, wherein the third-party source of guarantor financial information is selected from a group of third-parties as a function of actual outcome data.

12. A method comprising:

determining a probability that patient healthcare service charges will be paid as a function of patient information and guarantor financial information obtained from a third party, wherein the probability is determined as a function of a payment probability model;

maintaining, in a data repository, the determined probability, the patient information, the guarantor financial information, an indication of the third party source of the financial information, and received patient payment history associated with charges for the patient healthcare services; and

refining the payment probability model as a function of information including the determined probability, the patient information, the guarantor financial information, an indication of the third party 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.

13. The method of claim 12, wherein refining the payment probability model includes changing the third party source of financial information to determine the payment probability.

14. A computer readable medium, with instructions thereon to cause a system to perform the method of claim 13.

15. The method of claim 12, wherein the third party is a credit bureau.

16. The method of claim 12, wherein the third party source is a healthcare specific credit bureau.

17. The method of claim 12, wherein the data repository is a database.

18. A method to make customer credit decisions comprising:

receiving customer information from customers and from one or more third parties; and

determining customer categories as a function of the received information and one or more credit models, wherein the one or more credit models are generated according to customized rules, determined third party information accuracy, and historical data from one or more customers, wherein the method is performed by a computing system comprising one or more computing devices.

19. The method of claim 18, wherein the one or more credit models are refined to account for additional historical data.

20. The method of claim 18, wherein each customer category is associated with a probability that a customer will pay for charges.

21. The method of claim 20, further comprising:

modifying customer charges as a function of a determined customer category.

22. The method of claim 21, wherein the customer information includes a customer income level, and further wherein modifying customer charges includes modifying the customer charges as a function of a relationship between the customer income level and a threshold.

23. The method of claim 22, wherein the threshold is a poverty threshold.

24. The method of claim 21, wherein modifying the customer charges includes modifying the customer charges as function of a relationship between the customer probability of payment and a threshold.

25. The method of claim 18, wherein the third-party is an organization that maintains consumer data.

26. A method of selecting a third-party source of financial information, the method comprising:

maintaining patient guarantor financial information obtained from third-parties;

maintaining actual outcome data of guarantor collection activity; and

selecting a third-party source of financial information for specific criteria as a function of at least the maintained guarantor financial information and the actual outcome data, wherein the method is performed by a computing system comprising one or more computing devices.

27. The method of selecting a third-party source of financial information of claim 26, wherein the third-party source is a credit bureau.

28. The method of selecting a third-party source of financial information of claim 26, wherein the specific criteria is at least a portion of a guarantor zip code.

29. The method of selecting a third-party source of financial information of claim 26, wherein selecting the third-party source of financial information for specific criteria includes:

determining guarantor financial information obtained from a third-party is accurate when a payment is received on a guarantor account;

determining guarantor financial information obtained from a third-party is not accurate when an attempt to contact a guarantor is not successful;

maintaining a database of accuracy determinations; and

selecting the third-party source of guarantor financial information from the database of accuracy determination based on the specific criteria.