Systems and methods for automated extraction and processing of billing information in patient records

• US 20050137910A1
• Filed: 12/19/2003
• Published: 06/23/2005
• Est. Priority Date: 12/19/2003
• Status: Abandoned Application

• Current Assignee: Siemens Medical Solutions USA Incorporated (Siemens AG)
• Original Assignee: Siemens Medical Solutions USA Incorporated (Siemens AG)
• Inventors: Sandilya, Sathyakama, Niculescu, Radu Stefan, Rao, R. Bharat
• Application Number:
  US10/741,503
• Publication Number:
  US 20050137910A1
• Time in Patent Office: Days
• US Class Current: 705/3
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/04 Billing or invoicing
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records

Abstract

Systems and methods for automated processing of medical information in electronic patient medical record databases, wherein billing information (e.g., diagnosis codes, procedural codes) is automatically extracted from electronic patient medical records through comprehensive analysis of clinical information included in the patient medical records using a knowledge base of domain-specific criteria. The extracted billing information can be automatically processed for purposes of, e.g., medical claims correction, medical claims billing, quality assurance of recorded billing information, or claim reimbursement tracking.

Claims

1. A method for processing medical information, comprising the steps of:

obtaining a medical record of a patient, wherein the medical record comprises patient information from one or more structured and unstructured data sources;

automatically extracting billing information from the medical record by analyzing the patient information in the medical record using domain-specific criteria; and

automatically updating the medical record of the patient using the extracted billing information.

2. The method of claim 1, wherein automatically updating the medical record comprises using the extracted billing information to (i) correct billing information in the medical record, which is determined to be incorrectly recorded in the medical record or (ii) insert billing information into the medical record, which is determined to be missing from the medical record.

3. The method of claim 1, further comprising presenting an updated medical record to a user for verification, wherein automatically updating the medical record of the patient is performed in the updated medical record is verified by the user.

4. The method of claim 1, wherein extracting billing information comprises extracting one or more billing codes.

5. The method of claim 4, wherein the billing codes comprise a diagnosis code, a procedure code or both.

6. The method of claim 1, wherein the patient information comprises clinical information and financial information of the patient.

7. The method of claim 1, wherein extracting billing information comprises extracting all billing codes that are supported by the patient information based on all domain-specific criteria in a domain knowledge base.

8. The method of claim 1, wherein the domain-specific criteria comprises institution-specific domain knowledge.

9. The method of claim 8, wherein the institution-specific domain knowledge relates to one or more of data at a hospital, document structures at a hospital, policies of a hospital, guidelines of a hospital, and variations at a hospital.

10. The method of claim 1, wherein the domain-specific criteria includes condition-specific or disease-specific domain knowledge.

11. The method of claim 10, wherein the condition-specific or disease-specific domain knowledge includes one or more of factors that influence risk of a condition or disease, disease progression information, complications information, outcomes and variables related to a condition or disease, measurements related to a condition or disease, and policies and guidelines established by medical bodies.

12. The method of claim 1, further comprising generating an explanation that includes one or more pointers to relevant patient information, relevant domain-specific criteria, or relevant patient information and domain-specific criteria, which supports the extracted billing information.

13. A program storage device readable by machine, tangibly embodying a program of instructions executable by the machine to perform method steps for processing medical information, the method steps comprising:

obtaining a medical record of a patient, wherein the medical record comprises patient information from one or more structured and unstructured data sources;

automatically extracting billing information from the medical record by analyzing the patient information in the medical record using domain-specific criteria; and

automatically updating the medical record of the patient using the extracted billing information.

14. The program storage device of claim 13, wherein the instructions for automatically updating the medical record comprise instructions for using the extracted billing information to (i) correct billing information in the medical record, which is determined to be incorrectly recorded in the medical record or (ii) insert billing information into the medical record, which is determined to be missing from the medical record.

15. The program storage device of claim 13, further comprising instructions for presenting an updated medical record to a user for verification, wherein automatically updating the medical record of the patient is performed in the updated medical record is verified by the user.

16. The program storage device of claim 13, wherein extracting billing information comprises extracting one or more billing codes.

17. The program storage device of claim 16, wherein the billing codes comprise a diagnosis code, a procedure code or both.

18. The program storage device of claim 13, wherein the patient information comprises clinical information and financial information of the patient.

19. The program storage device of claim 13, wherein the instructions for extracting billing information comprise instructions for extracting all billing codes that are supported by the patient information based on all domain-specific criteria in a domain knowledge base.

20. The program storage device of claim 13, wherein the domain-specific criteria comprises institution-specific domain knowledge.

21. The program storage device of claim 20, wherein the institution-specific domain knowledge relates to one or more of data at a hospital, document structures at a hospital, policies of a hospital, guidelines of a hospital, and variations at a hospital.

22. The program storage device of claim 13, wherein the domain-specific criteria includes condition-specific or disease-specific domain knowledge.

23. The program storage device of claim 22, wherein the condition-specific or disease-specific domain knowledge includes one or more of factors that influence risk of a condition or disease, disease progression information, complications information, outcomes and variables related to a condition or disease, measurements related to a condition or disease, and policies and guidelines established by medical bodies.

24. The program storage device of claim 13, further comprising instructions for generating an explanation that includes one or more pointers to relevant patient information, relevant domain-specific criteria, or relevant patient information and domain-specific criteria, which supports the extracted billing information.

25. A system for processing medical information, comprising:

a knowledge base comprising domain-specific criteria; and

an engine that automatically extracts billing information from a medical record, which comprises patient information from one or more structured and unstructured data sources, by analyzing the patient information using the domain-specific criteria, and automatically updates the medical record of the patient using the extracted billing information.

26. The system of claim 25, wherein the engine automatically updates the medical record by using the extracted billing information to (i) correct billing information in the medical record, which is determined to be incorrectly recorded in the medical record or (ii) insert billing information into the medical record, which is determined to be missing from the medical record.

27. The system of claim 25, wherein the engine extracts billing information comprising billing codes.

28. The system of claim 27, wherein the billing codes comprise diagnosis codes, procedure codes, or both.

29. The system of claim 25, wherein the engine generates an explanation that includes one or more pointers to relevant patient information, relevant domain-specific criteria, or relevant patient information and domain-specific criteria, which supports the extracted billing information.

30. The system of claim 29, further comprising a user interface for presenting the explanation to a user to enable the user to verify the extracted billing information.

31. The system of claim 25, further comprising a user interface that presents an updated medical record to a user and enables the user to verify the updated medical record before automatically updating the medical record of the patient.

32. The system of claim 25, wherein the system operates as a service by a service provider for processing patient medical records in a database of a subscribing entity.