Dynamic Superbill Coding Workflow

• US 20140343963A1
• Filed: 03/18/2014
• Published: 11/20/2014
• Est. Priority Date: 03/15/2013
• Status: Abandoned Application

• Current Assignee: MModal IP LLC (3M Company)
• Original Assignee: MModal IP LLC (3M Company)
• Inventors: Fritsch, Juergen, Jagannathan, Vasudevan
• Application Number:
  US14/218,220
• Publication Number:
  US 20140343963A1
• 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

A computer system generates an initial set of billing codes based on one or more documents (e.g., clinical notes) representing a patient encounter, such as clinical notes created by a physician. The system expands the initial set of billing codes based on a billing code standard to create an expanded set of billing codes for consideration by the physician. The system provides output representing the expanded billing code set to the physician. The physician selects one or more billing codes from the expanded billing code set for inclusion in a final billing code set for use in a bill for the services provided in the patient encounter.

Claims

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) generating an initial set of billing codes based on at least one document, wherein the at least one document describes an encounter with a patient;

(B) expanding the initial set of billing codes to include, in addition to the initial set of billing codes, billing codes related to the initial set of billing codes encoded according to a billing code standard, thereby creating an expanded set of billing codes;

(C) generating, based on the expanded set of billing codes, output representing the expanded set of billing codes, wherein the output includes content not encoded according to the billing code standard;

(D) providing, to a user, the output representing the expanded set of billing codes;

(E) receiving, from the user, input selecting a subset of the expanded set of billing codes, wherein the subset consists of fewer than all of the expanded set of billing codes; and

(F) generating a final set of billing codes, encoded according to the billing code standard, based on the subset selected by the user.

2. The method of claim 1, wherein the output omits content included within the expanded set of billing codes.

3. The method of claim 1, wherein the output includes content not included within the expanded set of billing codes.

4. The method of claim 1, wherein (E) comprises receiving, from the user, input in association with a portion of the output representing the expanded set of billing codes.

5. The method of claim 4, wherein the input in association with the portion of the output representing the expanded set of billing codes represents input selecting the portion of the output representing the expanded set of billing codes.

6. The method of claim 1, wherein the final set of billing codes does not include billing codes not contained within the subset selected by the user.

7. The method of claim 1, further comprising:

(F) before (A), generating the at least one document by transcribing speech of a user describing the encounter with the patient.

8. The method of claim 1, wherein (A) comprises generating the initial set of billing codes based on at least one clinical note describing the encounter with the patient and at least one electronic health record of the patient.

9. The method of claim 8, further comprising identifying the at least one electronic health record of the patient based on the at least one clinical note.

10. The method of claim 1, wherein (A) comprises generating the initial set of billing codes based on at least one clinical note describing the encounter with the patient, at least one electronic health record of the patient, and at least one electronic health record of a patient other than the patient.

11. The method of claim 1, wherein (A) comprises:

(A)(1) generating a seed set of billing codes;

(A)(2) filtering the seed set of billing codes based on the at least one document to produced a filtered set of billing codes; and

(A)(3) generating the initial set of billing codes based on the filtered set of billing codes.

12. The method of claim 11, wherein (A)(1) comprises generating the seed set of billing codes based on the at least one document.

13. The method of claim 11, wherein (A)(1) comprises generating the seed set of billing codes based on an electronic health record of the patient.

14. The method of claim 11, wherein the at least one document includes a plurality of encoded concepts, and wherein (A)(2) comprises removing, from the seed set of billing codes, billing codes not associated with any of the plurality of encoded concepts in the at least one document.

15. The method of claim 1, wherein the at least one document includes a plurality of encoded concepts, and wherein (A) comprises:

(A)(1) mapping the plurality of encoded concepts to a plurality of billing codes within the billing code standard; and

(A)(2) generating the initial set of billing codes based on the plurality of billing codes within the billing code standard.

16. The method of claim 1, wherein (B) comprises:

(B) (1) identifying, for each billing code C in the initial set of billing codes, based on the billing code standard, at least one billing code that is related to billing code C; and

(B) (2) adding the at least one billing code that is related to billing code C to the expanded set of billing codes.

17. The method of claim 1, wherein (E) comprises generating the final set of billing codes to contain solely the subset selected by the user.

18. The method of claim 1, further comprising:

(G) revising billing code extraction data based on the input selecting the subset of the expanded set of billing codes; and

(H) generating a further initial set of billing codes based on the at least one document and the revised billing code extraction data.

19. The method of claim 1, further comprising:

(G) receiving a modified version of the at least one document; and

(H) applying (A)-(F) to the modified version of the at least one document.

20. A system comprising at least one non-transitory computer-readable medium having computer program instructions stored thereon, wherein the computer program instructions are executable by at least one computer processor to perform a method, the method comprising:

(A) generating an initial set of billing codes based on at least one document, wherein the at least one document describes an encounter with a patient;

(B) expanding the initial set of billing codes to include, in addition to the initial set of billing codes, billing codes related to the initial set of billing codes encoded according to a billing code standard, thereby creating an expanded set of billing codes;

(C) generating, based on the expanded set of billing codes, output representing the expanded set of billing codes, wherein the output includes content not encoded according to the billing code standard;

(D) providing, to a user, the output representing the expanded set of billing codes;

(E) receiving, from the user, input selecting a subset of the expanded set of billing codes, wherein the subset consists of fewer than all of the expanded set of billing codes; and

(F) generating a final set of billing codes, encoded according to the billing code standard, based on the subset selected by the user.

21. The system of claim 20, wherein the output omits content included within the expanded set of billing codes.

22. The system of claim 20, wherein the output includes content not included within the expanded set of billing codes.

23. The system of claim 20, wherein (E) comprises receiving, from the user, input in association with a portion of the output representing the expanded set of billing codes.

24. The system of claim 23, wherein the input in association with the portion of the output representing the expanded set of billing codes represents input selecting the portion of the output representing the expanded set of billing codes.

25. The system of claim 20, wherein the final set of billing codes does not include billing codes not contained within the subset selected by the user.

26. The system of claim 20, wherein the method further comprises:

(F) before (A), generating the at least one document by transcribing speech of a user describing the encounter with the patient.

27. The system of claim 20, wherein (A) comprises generating the initial set of billing codes based on at least one clinical note describing the encounter with the patient and at least one electronic health record of the patient.

28. The system of claim 27, wherein the method further comprises identifying the at least one electronic health record of the patient based on the at least one clinical note.

29. The system of claim 20, wherein (A) comprises generating the initial set of billing codes based on at least one clinical note describing the encounter with the patient, at least one electronic health record of the patient, and at least one electronic health record of a patient other than the patient.

30. The system of claim 20, wherein (A) comprises:

(A)(1) generating a seed set of billing codes;

(A)(2) filtering the seed set of billing codes based on the at least one document to produced a filtered set of billing codes; and

(A) (3) generating the initial set of billing codes based on the filtered set of billing codes.

31. The system of claim 30, wherein (A)(1) comprises generating the seed set of billing codes based on the at least one document.

32. The system of claim 30, wherein (A)(1) comprises generating the seed set of billing codes based on an electronic health record of the patient.

33. The system of claim 30, wherein the at least one document includes a plurality of encoded concepts, and wherein (A)(2) comprises removing, from the seed set of billing codes, billing codes not associated with any of the plurality of encoded concepts in the at least one document.

34. The system of claim 20, wherein the at least one document includes a plurality of encoded concepts, and wherein (A) comprises:

(A)(1) mapping the plurality of encoded concepts to a plurality of billing codes within the billing code standard; and

(A)(2) generating the initial set of billing codes based on the plurality of billing codes within the billing code standard.

35. The system of claim 20, wherein (B) comprises:

(B)(1) identifying, for each billing code C in the initial set of billing codes, based on the billing code standard, at least one billing code that is related to billing code C; and

(B)(2) adding the at least one billing code that is related to billing code C to the expanded set of billing codes.

36. The system of claim 20, wherein (E) comprises generating the final set of billing codes to contain solely the subset selected by the user.

37. The system of claim 20, wherein the method further comprises:

(G) revising billing code extraction data based on the input selecting the subset of the expanded set of billing codes; and

(H) generating a further initial set of billing codes based on the at least one document and the revised billing code extraction data.

38. The system of claim 20, wherein the method further comprises:

(G) receiving a modified version of the at least one document; and

(H) applying (A)-(F) to the modified version of the at least one document.