HEALTH CARE SYSTEM

• US 20110029322A1
• Filed: 07/30/2010
• Published: 02/03/2011
• Est. Priority Date: 04/11/2007
• Status: Abandoned Application

• Current Assignee: Walid A. Hindo
• Original Assignee: Walid Hindo
• Inventors: Ravi, Subbu, Hindo, Walid A.
• Application Number:
  US12/847,946
• Publication Number:
  US 20110029322A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems
• CPC Class Codes: G16H 70/60 relating to pathologies

Abstract

An automated system for determining authorization or denial of payment for a medical technique or process includes a user interface configured to receive data related to patient symptoms and diagnosis information, a database configured to store data related to patient symptoms and diagnosis information, and a processor configured to automatically determine authorization or denial of the medical technique or process based on data related to patient symptoms and diagnosis information. The data related to patient symptoms and diagnosis information is received from at least one of the user interface and the database. The processor is configured to provide an indication of authorization or denial to the user interface.

Claims

1. An automated system for determining authorization or denial of payment for a medical technique or process, comprising:

a user interface configured to receive data related to patient symptoms and diagnosis information;

a database configured to store data related to patient symptoms and diagnosis information; and

a processor configured to automatically determine authorization or denial of the medical technique or process based on data related to patient symptoms and diagnosis information, the data related to patient symptoms and diagnosis information being received from at least one of the user interface and the database, the processor configured to provide an indication of authorization or denial to the user interface.

2. The system of claim 1, wherein the processor determines authorization or denial using a causal decision tree, the processor traversing the decision tree using data related to patient symptoms and diagnosis information to determine authorization or denial.

3. The system of claim 1, wherein the medical technique or process is a technique or process for diagnosis, treatment, or testing.

4. The system of claim 1, wherein the medical technique or process is a medical imaging technique or process.

5. The system of claim 4, wherein the medical imaging technique or process comprises at least one of radiology, radiological sciences, endoscopy, thermography, medical photography and microscopy, electroencephalography, magnetoencephalography, magnetic resonance imaging, nuclear imaging, tomography, and fluoroscopy.

6. The system of claim 1, wherein the processor is executed by a server, the server communicating over a network with at least one of the user interface and the database.

7. The system of claim 6, wherein the database is stored on the server or on another server.

8. The system of claim 1, wherein the user interface is located on a laptop computer, a desktop computer, or a workstation.

9. The system of claim 8, wherein the processor is executed by the laptop computer, desktop computer, or workstation.

10. The system of claim 8, wherein the database is stored on a server or on the laptop computer, desktop computer, or workstation.

11. An automated method for determining authorization or denial of payment for a medical technique or process, comprising:

receiving data related to patient symptoms and diagnosis information at a user interface;

storing data related to patient symptoms and diagnosis information on a database;

automatically determining authorization or denial of the medical technique or process based on data related to patient symptoms and diagnosis information using a processor, the data related to patient symptoms and diagnosis information being received from at least one of the user interface and the database; and

providing an indication of authorization or denial from the processor to the user interface.

12. The method of claim 11, wherein the processor determines authorization or denial using a causal decision tree, the processor traversing the decision tree using data related to patient symptoms and diagnosis information to determine authorization or denial.

13. The method of claim 11, wherein the medical technique or process is a technique or process for diagnosis, treatment, or testing.

14. The method of claim 11, wherein the medical technique or process is a medical imaging technique or process.

15. The method of claim 14, wherein the medical imaging technique or process comprises at least one of radiology, radiological sciences, endoscopy, thermography, medical photography and microscopy, electroencephalography, magnetoencephalography, magnetic resonance imaging, nuclear imaging, tomography, and fluoroscopy.

16. The method of claim 11, wherein the processor is executed by a server, the server communicating over a network with at least one of the user interface and the database.

17. The method of claim 16, wherein the database is stored on the server, on another server, on a laptop computer, on a desktop computer, or on a workstation.

18. The method of claim 11, wherein the user interface is located on a laptop computer, a desktop computer, or a workstation.

19. The method of claim 11, wherein the processor is executed by a laptop computer, desktop computer, or workstation.

20. An automated system for determining authorization or denial of payment for a medical technique or process, comprising:

means for receiving data related to patient symptoms and diagnosis information;

means for storing data related to patient symptoms and diagnosis information;

means for automatically determining authorization or denial of the medical technique or process based on data related to patient symptoms and diagnosis information, the data related to patient symptoms and diagnosis information being received from at least one of the user interface and the database; and

means for providing an indication of authorization or denial.