Auditing the Coding and Abstracting of Documents

• US 20070226211A1
• Filed: 03/27/2007
• Published: 09/27/2007
• Est. Priority Date: 03/27/2006
• Status: Active Grant

• Current Assignee: Optum360, LLC (UnitedHealth Group Incorporated)
• Original Assignee: Optum360, LLC (UnitedHealth Group Incorporated)
• Inventors: Morsch, Mark, Heinze, Daniel, Feller, Peter
• Granted Patent: US 8,731,954 B2
• Time in Patent Office: Days
• US Class Current: 1/1
• CPC Class Codes: G06F 16/93 Document management systems
• CPC Class Codes: G06Q 50/22 Social work or social welfare, e.g. community support activities or counselling services
• CPC Class Codes: G16H 10/00 ICT specially adapted for the handling or processing of patient-related medical or healthcare data for medical reports G16H15/00; for therapies or health-improving plans G16H20/00; for the handling or processing of medical images G16H30/00
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
• CPC Class Codes: G16H 50/50 for simulation or modelling of medical disorders
• CPC Class Codes: G16H 50/70 for mining of medical data, e.g. analysing previous cases of other patients
• CPC Class Codes: G16H 70/00 ICT specially adapted for the handling or processing of medical references

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.

Claims

1. A Method of evaluating coded medical documents, the method comprising:

receiving one or more audit parameters;

selecting a sample batch of coded documents from a universe of coded documents based at least in part on the received audit parameters;

processing one or more documents of the selected sample batch to calculate a document score for each processed document based on corrections corresponding to the processed document received from one or more auditors; and

calculating a sample score based on a function of the document scores, the sample score correlating to subjective auditor assessments of a coding process used to code the selected sample batch of coded documents.

2. The method of claim 1, wherein corrections are made embedded within the sample batch of coded documents.

3. The method of claim 1, further comprising recording the corrections.

4. The method of claim 1, wherein calculating a sample score based on a function of the document scores comprises obtaining a summation of the calculated document scores.

5. The method of claim 1, wherein calculating the sample score comprises defining a quality of the coding process based on the subjective auditor assessments as being one of an acceptable quality, a marginal quality and an unacceptable quality.

6. The method of claim 1, further comprising assigning a weight to each of a plurality of factors used in calculating the document score.

7. The method of claim 6, wherein calculating the document score based on the received corrections comprises obtaining a summation of the weights assigned to the factors.

8. The method of claim 1, further comprising calculating a defect level based on the sample score.

9. The method of claim 8, further comprising adjusting the defect level to account for subjectivity and error of the auditors.

10. The method of claim 1, further comprising:

controlling the audit parameters to change a size of the sample batch;

empirically establishing a level of auditor subjectivity and error;

defining an upper control limit and a lower control limit based on the empirically established level of auditor subjectivity and error; and

comparing the sample score against the upper and lower control limits to determine whether the coding process is in control.

11. The method of claim 1, further comprising:

repeating the evaluation over a period of time to compile a plurality of sample scores; and

tracking a measure of variance in the compiled sample scores across the period of time.

12. A method of claim 11, further comprising tracking a measure of variance among the auditors.

13. A system of evaluating coded medical documents, the system comprising:

a user interface device; and

one or more computers communicatively coupled to the user interface device, the one or more computers including a processor and a display configured to provide a graphical user interface to one or more auditors, the graphical user interface configured to

receive from the auditors one or more audit parameters,

select a sample batch of coded documents from a universe of coded documents based at least in part on the received audit parameters,

process one or more documents of the sample batch to calculate a document score for each processed document based on corrections corresponding to the processed document received from the auditors, and

calculate a sample score based on a function of the document scores, the sample score representing subjective auditor assessments of a coding process used to code the selected sample batch of coded documents.

14. The system of claim 13, wherein the received corrections are embedded within the sample batch of coded documents.

15. The system of claim 13, wherein the graphical user interface is further configured to facilitate recording of the received corrections.

16. The system of claim 13, wherein the graphical user interface is further configured to facilitate calculation of the sample score based on a function of the document scores comprising a summation of the calculated document scores.

17. The system of claim 13, wherein the sample score based on the subjective auditor assessments defines a quality of the coding process as being one of an acceptable quality, a marginal quality and an unacceptable quality.

18. The system of claim 13, wherein the graphical user interface is further configured to allow the auditors to assigning a weight to each of a plurality of factors used in calculating the document score.

19. The system of claim 18, wherein each document score comprises a summation of the weights assigned to the factors

20. The system of claim 13, wherein the graphical user interface is further configured to facilitate calculation of a defect level based on the sample score.

21. The system of claim 20, wherein the graphical user interface is further configured to facilitate adjustment of the defect level to account for subjectivity and error of the auditors.

22. The system of claim 13, wherein the graphical user interface is further configured to facilitate:

control of the audit parameters to change a size of the sample batch;

establishment of a level of auditor subjectivity and error;

determination of an upper control limit and a lower control limit based on the established level of auditor subjectivity and error; and

comparison of the sample score against the upper and lower control limits to determine whether the coding process is in control.

23. The system of claim 13, wherein the graphical user interface is further configured to:

allow the auditors to repeat the evaluation over a period of time to compile a plurality of sample scores; and

track a measure of variance in the complied sample scores across the period of time.

24. A system of claim 23, wherein the graphical user interface is further configured to track a measure of variation among the auditors.

25. A computer program product, embodied in a computer readable medium, operable to cause a data processing apparatus to perform operations comprising:

selecting one or more audit parameters;

obtaining a sample batch of coded documents from a universe of coded documents based at least in part on the selected audit parameters;

processing one or more documents of the sample batch to calculate a document score for each processed document based on corrections corresponding to the processed document received from one or more auditors; and

calculating a sample score based on a function of the document scores, the sample score representing subjective auditor assessments of a coding process used to code the selected sample batch of coded documents.

26. The computer program product of claim 25, further operable to cause a data processing apparatus to perform operations comprising embedding the corrections within the sample batch of coded documents.

27. The computer program product of claim 25, further operable to cause a data processing apparatus to perform operations comprising facilitating recording of the received corrections.

28. The computer program product of claim 25, further operable to cause a data processing apparatus to facilitate calculation of the sample score based on a function comprising a summation of the calculated document scores.

29. The computer program product of claim 25, further operable to cause a data processing apparatus to define a quality of the coding process based on the subjective auditor assessments as being one of an acceptable quality, a marginal quality and an unacceptable quality.

30. The computer program product of claim 25, further operable to cause a data processing apparatus to assign a weight to each of a plurality of factors used in calculating each document score.

31. The computer program product of claim 30, further operable to cause a data processing apparatus to calculate each document score based on the received corrections by summing the weights assigned to the factors.

32. The computer program product of claim 25, further operable to cause a data processing apparatus to calculate a defect level based on the sample score.

33. The computer program product of claim 32, further operable to cause a data processing apparatus to adjust the defect level to account for subjectivity and error of the auditors.

34. The computer program product of claim 25, further operable to cause a data processing apparatus to perform operations comprising:

controlling the audit parameters to change a size of the sample batch;

empirically establishing a level of auditor subjectivity and error;

defining an upper control limit and a lower control limit based on the empirically established level of auditor subjectivity and error; and

comparing the sample score against the upper and lower control limits to determine whether the coding process is in control.

35. The computer program product of claim 25, further operable to cause a data processing apparatus to perform operations comprising:

repeating the evaluation over a period of time to compile a plurality of sample scores; and

tracking a measure of variance in the sample scores across the period of time.

36. A computer program product of claim 35, further operable to cause a data processing apparatus to track a measure of variance among the auditors.