Auditing the coding and abstracting of documents
First Claim
1. A method performed by a computer of evaluating coded medical documents, the method comprising:
- receiving, by a computer, audit parameters comprising an expected coder error level, and receiving an empirically established expected auditor error level of an auditor based on an assessment of the auditor;
selecting, by the computer, a sample batch of coded medical documents for auditing by the auditor, the sample batch of coded medical documents selected from a universe of coded medical documents stored on one or more storage devices, the selection based at least in part on the received audit parameters;
receiving, by the computer, audited medical documents corresponding to the selected sample batch of coded medical documents, wherein the audited medical documents include corrections by the auditor;
calculating, by the computer, a medical document score for each of the audited medical documents based on medical document corrections received from the auditor and applying weighted factors, wherein the weighted factors comprise predefined weights assigned to diagnosis and procedure codes in each of the audited medical documents;
calculating, by the computer, a sample score for the audited medical documents based on a function of the calculated medical document scores;
designating, by the computer, at least one of an upper control limit and a lower control limit based on the expected auditor error level; and
comparing, by the computer, the sample score against the at least one of the upper and lower control limits to determine an acceptability of the sample score.
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Accused Products
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.
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Citations
30 Claims
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1. A method performed by a computer of evaluating coded medical documents, the method comprising:
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receiving, by a computer, audit parameters comprising an expected coder error level, and receiving an empirically established expected auditor error level of an auditor based on an assessment of the auditor; selecting, by the computer, a sample batch of coded medical documents for auditing by the auditor, the sample batch of coded medical documents selected from a universe of coded medical documents stored on one or more storage devices, the selection based at least in part on the received audit parameters; receiving, by the computer, audited medical documents corresponding to the selected sample batch of coded medical documents, wherein the audited medical documents include corrections by the auditor; calculating, by the computer, a medical document score for each of the audited medical documents based on medical document corrections received from the auditor and applying weighted factors, wherein the weighted factors comprise predefined weights assigned to diagnosis and procedure codes in each of the audited medical documents; calculating, by the computer, a sample score for the audited medical documents based on a function of the calculated medical document scores; designating, by the computer, at least one of an upper control limit and a lower control limit based on the expected auditor error level; and comparing, by the computer, the sample score against the at least one of the upper and lower control limits to determine an acceptability of the sample score. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10)
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11. A system of evaluating coded medical documents, the system comprising:
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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 an auditor, the one or more computers configured to perform operations including; receive audit parameters comprising an expected coder error level, and receiving an empirically established expected auditor error level of an auditor based on an assessment of the auditor; select a sample batch of coded medical documents for auditing by the auditor, the sample batch of coded medical documents selected from a universe of coded medical documents stored on one or more storage devices, the selection based at least in part on the received audit parameters; receive audited medical documents corresponding to the selected sample batch of coded medical documents, wherein the audited medical documents include corrections by the auditor; calculate a medical document score for each of the audited medical documents based on medical document corrections received from the auditor and applying weighted factors, wherein the weighted factors comprise predefined weights assigned to diagnosis and procedure codes in each of the audited medical documents; calculate a sample score for the audited medical documents based on a function of the calculated medical document scores; designate at least one of an upper control limit and a lower control limit based on the expected auditor error level; and compare the sample score against the at least one of the upper and lower control limits to determine an acceptability of the sample score. - View Dependent Claims (12, 13, 14, 15, 16, 17, 18, 19, 20)
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21. A non-transitory computer readable medium storing instructions that when executed by a computer cause the computer to perform operations comprising:
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receiving an empirically established expected auditor error level of an auditor based on an assessment of the auditor; selecting audit parameters comprising an expected coder error level and the empirically established expected auditor error level of the auditor; selecting a sample batch of coded medical documents for auditing by the auditor, the sample batch of coded medical documents selected from a universe of coded medical documents stored on one or more storage devices, the selection based at least in part on the selected audit parameters; receiving audited medical documents corresponding to the selected sample batch of coded medical documents, wherein the audited medical documents include corrections by the auditor; calculating a medical document score for each of the audited medical documents based on medical document corrections received from the auditor and applying weighted factors, wherein the weighted factors comprise predefined weights assigned to diagnosis and procedure codes in each of the audited medical documents; calculating a sample score for the audited medical documents based on a function of the calculated medical document scores; designating at least one of an upper control limit and a lower control limit based on the expected auditor error level; and comparing the sample score against the at least one upper and lower control limits to determine an acceptability of the sample score. - View Dependent Claims (22, 23, 24, 25, 26, 27, 28, 29, 30)
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Specification