US 10,832,811 B2Granted

Auditing the coding and abstracting of documents

AssigneeOptum360, LLC

InventorsDaniel T. Heinze, Peter Feller, Mark L. Morsch

Life of this patent

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Abstract

Techniques for implementing Quality Assurance of the process of coding medical documents are disclosed. An audit of a coding process for a medical document is initiated by selecting and setting audit parameters. Using the selected parameters, a sample batch of coded documents is obtained from a universe of coded documents. The sample batch of coded documents is presented to auditor(s), and the auditor(s) provide corrections, which are recorded, and a score for each correction is calculated. A sample score, based on the corrections, is calculated in a manner that tracks to subjective auditor assessments of the process quality as being acceptable, marginally acceptable, or unacceptable, and which sample score accounts for the individual auditor subjectivity and an error.

Claims20

Dependent claims

A method of evaluating coded medical documents performed by a computer, the method comprising:

providing, by a computer, a graphical user interface (GUI) wizard;
receiving, by the computer via the GUI wizard, audit parameters;
selecting, by the computer, a document universe based on the received audit parameters;
providing, by the computer via the GUI wizard, a plurality of medical documents coded by a coder using the audit parameters and the selected document universe;
receiving, by the computer via the GUI wizard, a plurality of corrections by an auditor to the plurality of medical documents;
recording, by the computer, the plurality of corrections to the coded medical documents to form a plurality of audited medical documents;
determining, by the computer, a document score for each of the plurality of audited medical documents, each document score based on one or more document corrections provided by the auditor and weighted factors, wherein the weighted factors comprise predefined weights assigned to diagnosis codes and finding codes of each of the plurality of audited medical documents;
determining, by the computer, a sample score for the plurality of audited medical documents based on the determined document scores;
determining, by the computer, the acceptability of the sample score by periodically performing an empirical test to compare the sample score to system control limits;
and
displaying, by the computer via the GUI, a graphical analysis comprising the sample score, an upper control limit, a lower control limit, and a previously determined sample score of audited medical documents coded by the coder.

8 more elements

A system configured to evaluate coded medical documents, the system comprising:

a graphical user interface (GUI);
and
one or more computers communicatively coupled to the graphical user interface, the one or more computers configured to:
provide a graphical user interface (GUI) wizard;
receive, via the GUI wizard, audit parameters;
select, by the computer, a document universe based on the received audit parameters;
provide, via the GUI wizard, a plurality of medical documents coded by a coder using the audit parameters and the selected document universe;
receive, via the GUI wizard, a plurality of corrections by an auditor to the plurality of medical documents;
record the plurality of corrections to the coded medical documents to form a plurality of audited medical documents;
determine a document score for each of the plurality of audited medical documents, each document score based on one or more document corrections provided by the auditor and weighted factors, wherein the weighted factors comprise predefined weights assigned to diagnosis codes and finding codes of each of the plurality of audited medical documents;
determine a sample score for the plurality of audited medical documents based on the determined document scores;
determine the acceptability of the sample score by periodically performing an empirical test to compare the sample score to system control limits;
and
display, via the GUI, a graphical analysis comprising the sample score, an upper control limit, a lower control limit, and a previously determined sample score of audited medical documents coded by the coder.

11 more elements

A non-transitory computer readable storage medium encoded with instructions executable by a processor that when executed instruct the processor to;

generate a graphical user interface (GUI) wizard;
receive, via the GUI wizard, audit parameters;
select, by the computer, a document universe based on the received audit parameters;
provide, via the GUI wizard, a plurality of medical documents coded by a coder using the audit parameters and the selected document universe;
receive, via the GUI wizard, a plurality of corrections by an auditor to the plurality of medical documents;
record the plurality of corrections to the coded medical documents to form a plurality of audited medical documents;
determine a document score for each of the plurality of audited medical documents, each document score based on one or more document corrections provided by the auditor and weighted factors, wherein the weighted factors comprise predefined weights assigned to diagnosis codes and finding codes of each of the plurality of audited medical documents;
determine a sample score for the plurality of audited medical documents based on the determined document scores;
determine the acceptability of the sample score by periodically performing an empirical test to compare the sample score to system control limits;
and
display, via the GUI, a graphical analysis comprising the sample score, an upper control limit, a lower control limit, and a previously determined sample score of audited medical documents coded by the coder.

8 more elements

Dependencies are inferred from the claim text.

Facts

Application: 16/250,634Filed 17 Jan 2019 · continuation
Priority: 27 Mar 2006
Published: US 2019/0156939 A123 May 2019
Granted: 10 Nov 2020
Term ends: Not estimatedThe source records don’t support an estimate.

Classification10 codes

G06F 16/93
Details of database functions independent of the retrieved data types: document management systems
G06Q 50/22
Services: social work or social welfare, e.g. community support activities or counselling services
G16H 10/00
Ict specially adapted for the handling or processing of patient-related medical or
G16H 40/20
ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or…:…

Family

Application60/786,507Us provisional application · filed 27 Mar 2006
Application11/692,093Parent of this continuation · filed 27 Mar 2007
Application14/271,719Parent of this continuation · filed 7 May 2014
US 8,731,954 B2Parent of this continuation · filed 20 May 2014
US 2019/0156939 A1Pre-grant publication · published 23 May 2019
US 10,216,901 B2Parent of this continuation
US 2007/0226211 A1Published application
US 2014/0257842 A1Published application
US 10,832,811 B2This patent

From the US filing history. Foreign family members aren’t listed.