Hybrid Human and Computer-Assisted Coding Workflow

Patent metadata

Field	Value
Publication number	US-2016267232-A1
Application number	US-201514941445-A
Country	US
Kind code	A1
Filing date	Nov 13, 2015
Priority date	Mar 13, 2015
Publication date	Sep 15, 2016
Grant date	—

Abstract

A computer system increases the efficiency with which billing codes may be generated based on a chart, such as a medical chart. The computer system provides the chart to a computer-assisted coding (CAC) module, which produces an initial set of billing codes and an initial assessment of the accuracy and/or completeness of the codes. The computer system decides whether to send the initial set of billing codes to an initial human reviewer. If the computer system sends the initial set of billing codes to the initial human reviewer, then the initial human reviewer reviews the chart and the output of the CAC module, and attempts to fix errors in the CAC output. The system provides the chart and the current (initial or modified) codes to a final human reviewer, who may be more highly skilled than the initial human reviewer, for final verification and modification.

First claim

What is claimed is:

1 . A method performed by at least one computer processor executing computer program instructions stored on at least one non-transitory computer-readable medium, the method comprising:
(A) receiving data representing a medical chart; (B) providing the medical chart to a computer-assisted coding (CAC) module; (C) receiving an initial set of billing codes from the CAC module; (D) providing the initial set of billing codes to an initial human reviewer; (E) receiving, from the initial human reviewer, a modified set of billing codes and data representing an assessment of accuracy and completeness of the initial set of billing codes; and (F) providing the medical chart and the modified set of billing codes to a final human reviewer.

2 . The method of claim 1 , further comprising:
(G) before (D), determining whether the initial set of billing codes should be provided to the initial human reviewer; and wherein (D) comprises providing the initial set of billing codes to the initial human reviewer in response to determining that the initial set of billing codes should be provided to the initial human reviewer.

3 . The method of claim 2 , wherein determining whether the initial set of billing codes should be provided to the initial human reviewer comprises determining whether the initial human reviewer is likely to add value to the initial set of billing codes.

4 . The method of claim 3 , wherein determining whether the initial human reviewer is likely to add value to the initial set of billing codes comprises determining whether the medical chart describes a complex medical procedure.

5 . The method of claim 3 , wherein determining whether the initial human review is likely to add value to the initial set of billing codes comprises determining whether the initial human reviewer is sufficiently skilled to add value to the initial set of billing codes.

6 . The method of claim 1 , further comprising:
(G) before (B), determining whether the medical chart qualifies for fully-automated coding; and wherein (B) comprises providing the medical chart to the CAC module in response to determining that the medical chart qualifies for fully-automated coding.

7 . The method of claim 1 , wherein the data representing the medical chart includes data representing a freeform text document.

8 . The method of claim 1 , wherein the data representing the medical chart includes data representing a structured document.

9 . The method of claim 5 , wherein the data representing the structured document comprises data representing an XML document.

10 . The method of claim 1 , wherein the data representing the medical chart comprises data representing a data record in a database.

11 . The method of claim 1 , wherein the data representing the medical chart includes data representing at least two of a freeform text document, an XML document, and a data record in a database.

12 . A system comprising at least one non-transitory computer-readable medium storing computer program instructions executable by at least one computer processor to perform a method, the method comprising:
(A) receiving data representing a medical chart; (B) providing the medical chart to a computer-assisted coding (CAC) module; (C) receiving an initial set of billing codes from the CAC module; (D) providing the initial set of billing codes to an initial human reviewer; (E) receiving, from the initial human reviewer, a modified set of billing codes and data representing an assessment of accuracy and completeness of the initial set of billing codes; and (F) providing the medical chart and the modified set of billing codes to a final human reviewer.

13 . The system of claim 12 , wherein the method further comprises:
(G) before (D), determining whether the initial set of billing codes should be provided to the initial human reviewer; and wherein (D) comprises providing the initial set of billing codes to the initial human reviewer in response to determining that the initial set of billing codes should be provided to the initial human reviewer.

14 . The system of claim 13 , wherein determining whether the initial set of billing codes should be provided to the initial human reviewer comprises determining whether the initial human reviewer is likely to add value to the initial set of billing codes.

15 . The system of claim 14 , wherein determining whether the initial human reviewer is likely to add value to the initial set of billing codes comprises determining whether the medical chart describes a complex medical procedure.

16 . The system of claim 14 , wherein determining whether the initial human review is likely to add value to the initial set of billing codes comprises determining whether the initial human reviewer is sufficiently skilled to add value to the initial set of billing codes.

17 . The system of claim 12 , wherein the method further comprises:
(G) before (B), determining whether the medical chart qualifies for fully-automated coding; and wherein (B) comprises providing the medical chart to the CAC module in response to determining that the medical chart qualifies for fully-automated coding.

18 . The system of claim 12 , wherein the data representing the medical chart includes data representing a freeform text document.

19 . The system of claim 12 , wherein the data representing the medical chart includes data representing a structured document.

20 . The system of claim 16 , wherein the data representing the structured document comprises data representing an XML document.

21 . The system of claim 12 , wherein the data representing the medical chart comprises data representing a data record in a database.

22 . The system of claim 12 , wherein the data representing the medical chart includes data representing at least two of a freeform text document, an XML document, and a data record in a database.

Assignees

• Mmodal Ip Llc

Inventors

• Koll Detlef
• Finke Michael
• Mckenna John
• Nichols Derek

Classifications

• G06F19/328 Primary

  Physics · mapped topic

• G06F19/322

  Physics · mapped topic

• G06Q10/10

  Office automation; Time management · CPC title

• G16H10/60 Primary

  for patient-specific data, e.g. for electronic patient records · CPC title