Method and apparatus for identifying patients overdue for an appointment using standard healthcare billing data

• US 8,655,699 B2
• Filed: 11/09/2007
• Issued: 02/18/2014
• Est. Priority Date: 07/10/2006
• Status: Active Grant

• Current Assignee: Brevium Incorporated
• Original Assignee: Brevium Incorporated
• Inventors: Perrin, Brian William, Gerlach, Brett Cornell
• Primary Examiner(s): DELICH, STEPHANIE ZAGARELLA
• Application Number:
  US11/938,087
• Publication Number:
  US 20090094054A1
• Time in Patent Office: 2,293 Days
• Field of Search: 705/2, 705/3, 705/5, 705/7.12, 705/7.13, 705/7.15, 705/7.18, 705/7.19
• US Class Current: 705/7.13
• CPC Class Codes: G06Q 10/0631 Resource planning, allocation, distributing or scheduling for enterprises or organisations
• CPC Class Codes: G06Q 10/06311 Scheduling, planning or task assignment for a person or group
• CPC Class Codes: G06Q 10/06375 Prediction of business process outcome or impact based on a proposed change
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 10/109 Time management, e.g. calendars, reminders, meetings or time accounting
• CPC Class Codes: G06Q 10/1093 Calendar-based scheduling for persons or groups
• CPC Class Codes: G06Q 10/1095 Meeting or appointment
• CPC Class Codes: G06Q 10/1097 Task assignment
• CPC Class Codes: G06Q 30/0201 Market modelling; Market analysis; Collecting market data
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms

Abstract

A method and apparatus for identifying overdue patients using standard billing or other office management data, so that patients can be contacted and invited to make an appointment. The invention begins by querying the diagnosis codes for each visit from the billing or other encounter tables, and matching these with a set of target medical conditions requiring regular care. Procedure codes and encounter dates for past visits are queried for these patients, to determine when each patient was last seen, and what was done. These procedure codes are matched against a set of exam codes to determine last medical examination dates, and against a set of procedures known to resolve each medical condition. Each condition requiring regular care is matched against any resolving procedures, leaving a set of untreated conditions requiring regular care. Based on the date of the last exam or treatment and accepted standards of care or office policies, a due date is calculated for each patient. The management system is queried for each overdue patient to determine whether they already have an appointment scheduled in the future, or a recall notice recently sent or yet to be sent. Additional filtering based on administrative settings may also be done. Overdue patients requiring contact are then placed on the contact list.

Claims

1. A computerized method for automatically identifying, using a computer running a medical or dental office practice management system and having a memory containing an office practice management system computer database and running a patient reactivation system and having a memory containing a patient reactivation system computer database, patients who are due for care so that those patients can be personally contacted by staff at a health care facility, comprising:

automatically querying a computerized medical or dental office practice management system database for standardized procedure or diagnostic codes in billing or other encounter data associated with past patient visits;

automatically identifying, using the standardized procedure or diagnostic codes, patients with medical conditions requiring regular care and storing data corresponding to the identified patients and their medical conditions in the patient reactivation system;

automatically determining a most recent date of treatment using billing or other encounter data from one of the computer databases;

automatically identifying patients who are due for care by comparing expected visit intervals for each condition with a time interval since the most recent date of treatment, and storing identifying data for the patients who are due for care in a contact list of the patient reactivation system;

automatically identifying patients who already have appointments or who will receive reminders to call for an appointment and automatically removing these patients from the contact list;

automatically identifying patients whose conditions have been resolved by comparing the standardized procedure or diagnostic codes with a set of procedures known to resolve each medical condition and automatically removing patients whose conditions have been resolved from the contact list;

displaying using a display on a computer screen patient identifying information to an operator, the patient information including at least an identified patient'"'"'s name, telephone number, and reason why the identified patient is due for care;

contacting the identified patients by telephone call by the operator; and

scheduling by the operator an appointment for healthcare while the patient is on the telephone.

2. The method of claim 1 in which scheduling an appointment includes transferring the telephone call to a scheduler.

3. The method of claim 1 further comprising displaying a screen that the operator can use to record results of the contact.

4. The method of claim 1 further comprising removing the patient from the contact list once the appointment has been scheduled.

5. A computerized method for automatically identifying, using a computer running a medical or dental office practice management system and having a memory containing an office practice management system computer database and running a patient reactivation system and having a memory containing a patient reactivation system computer database, patients who are due for care so that those patients can be personally contacted by staff at a health care facility, comprising:

automatically querying a computerized medical or dental office practice management system database for standardized procedure or diagnostic codes in billing or other encounter data associated with past patient visits;

automatically identifying, using the standardized billing or diagnostic codes, patients with medical conditions requiring regular care and storing data corresponding to the identified patients and their medical conditions in the patient reactivation system;

automatically determining a most recent date of treatment using billing or other encounter data from one of the computer databases;

automatically identifying patients who are due for care by comparing expected visit intervals for each condition with a time interval since the most recent date of treatment, and storing identifying data for the patients who are due for care in a contact list of the patient reactivation system;

automatically identifying patients who already have appointments or who will receive reminders to call for an appointment and automatically removing these patients from the contact list;

automatically identifying patients whose conditions have been resolved by comparing the standardized procedure or diagnostic codes with a set of procedures known to resolve each medical condition and automatically removing patients whose conditions have been resolved from the contact list;

displaying using a display on a computer screen patient identifying information to an operator, the patient information including at least the identified patient'"'"'s name, telephone number, and reason why the patient is due for care;

attempting to contact the identified patient by the operator;

entering results of the attempted contact in a computer; and

automatically determining from the entered results whether to schedule a follow-up contact.

6. The method of claim 5 further comprising displaying a screen that the operator can use to record the results of the attempted contact.

7. The method of claim 5 in which attempting to contact the patient includes receiving information indicating that the patient is not to be contacted and further comprising removing the patient from the contact list.

8. The method of claim 5 in which attempting to contact the patient includes receiving information indicating that the patient has a different telephone number and further comprising attempting to contact the patient using the new telephone number and recording the telephone number in the office database.

9. A computerized method for automatically identifying, using a computer running a medical practice management system having a computer database and a patient reactivation system having a computer database, and attempting to contact patients who are due for care, comprising:

automatically causing a computer to query a computerized medical or dental office practice management system database for standardized procedure or diagnostic codes in billing or other encounter data associated with past patient visits;

automatically causing a computer to identify, using the standardized procedure or diagnostic codes, patients with medical conditions requiring regular care and storing data corresponding to the identified patients and their medical conditions in the patient reactivation system;

automatically causing a computer to determine a most recent date of treatment using billing or other encounter data from the computer database;

automatically causing a computer to identify patients who are due for care by comparing expected visit intervals for each condition with a time interval since the most recent date of treatment, and storing identifying data for the patients who are due for care in a contact list of the patient reactivation system;

automatically causing a computer to identify patients who already have appointments or who are scheduled to receive reminders to call for an appointment and automatically removing these patients from the contact list;

automatically causing a computer to identify patients whose conditions have been resolved by comparing the standardized procedure or diagnostic codes with a set of procedures known to resolve each medical condition and automatically removing the patients whose conditions have been resolved from the contact list; and

attempting to contact patients on the contact list by an operator.

10. The method according to claim 9, further comprising eliminating from the contact list:

patients having specific insurance, patients over a given age, patients who have not been seen for a very long time, patients seen by specific doctors or at specific location, patients who have been discharged or are in collections, or patients who are deceased.

11. The method according to claim 9 in which attempting to contact patients on the contact list includes attempting to contact patients via a human caller using a telephone.

12. The method according to claim 9 in which attempting to contact patients on the contact list includes attempting to contact patients via an automated calling system.

13. The method according to claim 9, further comprising automatically generating recalls or mailing labels from the contact list to send patients written reminders to call for an appointment.

14. The method according to claim 9, further comprising automatically generating from the contact list email to patients requesting the patients to call for an appointment.

15. A non-transitory, computer-readable media having encoded thereon computer-readable instructions that, when executed by a computer, cause the computer to perform the steps of:

automatically querying a computerized medical or dental office practice management system database for standardized procedure or diagnostic codes in billing or other encounter data associated with past patient visits;

automatically identifying, using the standardized procedure or diagnostic codes, patients with medical conditions requiring regular care and storing data corresponding to the identified patients and their medical conditions in the patient reactivation system;

automatically determining a most recent date of treatment using billing or other encounter data from the database;

automatically identifying patients who are due for care by comparing expected visit intervals for each condition with a time interval since the most recent date of treatment, and storing identifying data for the patients who are due for care in a contact list of the patient reactivation system;

automatically identifying patients who already have appointments or who will receive a reminder to call for an appointment and automatically removing these patients from the contact list; and

automatically identifying patients whose conditions have been resolved by comparing the standardized procedure or diagnostic codes with a set of procedures known to resolve each medical condition and automatically removing the patients whose conditions have been resolved from the contact list.

16. A computerized method for identifying patients who are due for care in an office that schedules appointments for the office using a computer running an office practice management system, comprising the steps of:

causing a computer to identify patients with conditions requiring regular care using billing data from the practice management system;

causing a computer to identify patients whose conditions have been resolved using billing data from the practice management system, wherein procedure codes from the billing data are compared to a set of procedure codes known to resolve each condition;

causing a computer to determine a most recent date of treatment for unresolved conditions using billing data from the management system;

causing a computer to identify a first group of patients who are due for care by comparing expected visit intervals for each condition with a time interval since last treatment, and storing identifying information of the identified patients from the first group of patients in a contact list; and

causing a computer to identify a second group of patients whose conditions have been resolved, who already have appointments, or who will receive reminders to call for an appointment and removing identifying information of the identified patients from the second group of patients from the contact list.

17. The method according to claim 16, further comprising eliminating from the contact list patients based on one or more of the following criteria;

patients having specific insurance, patients over a given age, patients who have not been seen for a very long time, patients seen by specific doctors or at specific location, patients who have been discharged or are in collections, or patients who are deceased.

18. The method according to claim 16, further comprising using the contact list to drive personal contact with patients via a human caller using a telephone.

19. The method according to claim 16, further comprising using the contact list to drive contact with patients via an automated calling system.

20. The method according to claim 16, further comprising using the contact list to automatically generate recalls or mailing labels to send patients written reminders to call for an appointment.

21. The method according to claim 16, further comprising using the contact list to automatically generate email to patients reminding them to call for an appointment.

22. An apparatus for identifying patients who are due for care in an office that schedules appointments for the office using a practice management system, the apparatus comprising a computer programmed with computer instructions for carrying out the following steps:

automatically identifying, using standardized procedure or diagnostic codes in billing or other encounter data from a computerized medical practice management system, patients with conditions requiring regular care;

automatically identifying patients whose conditions have been resolved using billing data from the practice management system, wherein procedure codes from the billing data are compared to a set of procedure codes known to resolve each condition;

automatically determining a most recent date of treatment using billing or other encounter data from a database of the office management system;

automatically identifying patients who are due for care by comparing expected visit intervals for each condition with a time interval since last treatment, and storing patient information related to those identified patients in a contact list;

automatically identifying patients whose conditions have been resolved, who already have appointments, or who will receive reminders to call for an appointment and removing patient information related to those identified patients from the contact list.

23. A computerized method for automatically identifying, using a computer running a medical or dental office practice management system and having a memory containing an office practice management system computer database and running a patient reactivation system and having a memory containing a patient reactivation system computer database, patients who are due for care so that those patients can be personally contacted by staff at a health care facility, comprising:

automatically querying diagnostic codes for past patient visits from billing or other encounter tables in a practice management system database associated with a medical or dental practice;

automatically matching the diagnostic codes with a set of target codes for medical conditions requiring regular care and, for each matching diagnostic code, storing data in a patient-diagnosis table of a patient reactivation system database, the data at least identifying a patient and a diagnosis corresponding to the matching diagnostic code;

automatically querying procedure codes and encounter dates from billing or other encounter tables in the practice management system for each entry in the patient-diagnosis table identifying a patient and a diagnosis corresponding to the matching diagnostic code to determine when each patient was last seen and what procedures were performed;

automatically matching the procedure codes with a set of procedures known to resolve each medical condition and removing any entries in the patient-diagnosis table identifying a patient and a diagnosis corresponding to the matching diagnostic code for which a procedure has already been performed to resolve the diagnosis;

automatically matching the procedure codes with a set of exam codes to determine a most recent exam date and storing the most recent exam date for each entry in the patient-diagnosis table identifying a patient and a diagnosis corresponding to the matching diagnostic code;

automatically determining which entries in the patient-diagnosis table are overdue for care based on accepted standards of care or office policies and the most recent exam date for each entries in the patient-diagnosis table and storing in a contact list patient identifying data for each entry in the patient-diagnosis table identifying a patient and a diagnosis corresponding to the matching diagnostic code that is overdue for care;

automatically querying the practice management system database do determine which patients in the contact list have appointments scheduled, pending recall notices, or an administrative flag and removing these patients from the contact list; and

displaying the contact list to a user so that the user can contact one or more patients in the contact list to schedule an appointment for care.