Patent US4196730A successfully refreshed from Google Patents.
US5307262A
Expired / Lapsed
US
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Patient data quality review method and system
Assignee: APPLIED MEDICAL DATA Inc A CORP OF MICHIGAN
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Filing: 1992-01-29
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Granted: 1994-04-26
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Expires: 2012-01-29
Abstract
Abstract A method and system is provided to review and control clinical data quality in the reporting of hospital claims data. The method and system perform data quality checks and generate turn-around documents that establish communications between coders and physicians in order to obtain the best description of a case for reporting purposes. The system provides file security and tracks cases through the entire review process to final reporting. Patient data and system performance data are aggregated into a common data base. From this integrated data base, a variety of summary reports are generated to identify systematic problems in data quality and to assess the success of the data correction process. The system interfaces with existing data systems to optimize the performance efficiency of a total health information system functioning within a hospital or within third-party claims review organizations including payers of hospital claims.
Inventors
- 👤 Paul Y. Ertel
Bibliographic Details
Application Number
—
Jurisdiction
US
Data Source
google_patents
Last Synchronized
2026-10-24 04:59
CPC Classifications
G; G16; G16H; G16H15/00; G16H10/00; G16H10/60; G16H40/00; G16H40/20
Claims Analysis
Total Claims: 77
Claim 1
Independent Claim
325 words
In an automated patient data review system including a system memory, a program of instructions stored in the system memory, a processor coupled to the system memory and a system output device coupled to the processor, a method for automatically detecting, analyzing and classifying patient data reported on a plurality of payment claims, the method comprising the steps of: storing collections of patient data including patient identifiers and clinical data, misreporting tables and message tables in data files in the system memory; storing classification data and case review tables in the data files in the system memory; and automatically processing a plurality of patient cases, the step of processing the patient cases being performed by the processor in accordance with the program of instructions and including the steps of: determining whether misreporting conditions exist in the stored clinical data, the misreporting conditions including actual or potential non-compliance with federally mandated coding and reporting rules and actual or potential failure to properly report complexities of the case; generating at least one data quality message based upon the misreporting tables, the message tables and the determined misreporting conditions; classifying the data quality messages generated for a case based upon the probability and relative seriousness or consequences of noncompliance with federal coding and reporting rules or the failure to report case complexities adequately; displaying via the system output device the patient data including the patient identifiers and the clinical data; displaying via the system output device at least one message based on the determined misreporting conditions in the patient data; automatically accumulating aggregate case data and system analysis data on a plurality of patient cases and storing the aggregate case data and system analysis data in system data files in the system memory; automatically analyzing the aggregate case data in order to identify patterns of aggregate case data; and generating at least one analysis report for a plurality of patient cases based upon the analyzed aggregate case data.
Claim 2
Dependent Claim
30 words
The method as claimed in claim 1 wherein a plurality of data quality messages are generated and wherein the method further comprises the step of classifying the data quality messages.
Claim 3
Dependent Claim
22 words
The method as claimed in claim 2 wherein the step of classifying the data quality messages is performed in an hierarchical manner.
Claim 4
Dependent Claim
20 words
The method as claimed in claim 1 wherein the step of classifying each case is performed in an hierarchical manner.
Claim 5
Dependent Claim
24 words
The method as claimed in claim 1 wherein the step of classifying each case is based on the type of the determined misreporting condition.
Claim 6
Dependent Claim
28 words
The method as claimed in claim 1 wherein the step of classifying data quality messages generated for a case includes determining a probably cause of the misreporting conditions.
Claim 7
Dependent Claim
24 words
The method as claimed in claim 1 wherein the step of classifying each case is based on the consequences of the determined misreporting condition.
Claim 8
Dependent Claim
25 words
The method as claimed in claim 1 wherein the step of classifying the data quality messages for a case is based on user-defined prioritization criteria.
Claim 9
Dependent Claim
27 words
The method as claimed in claim 1 wherein the step of displaying patient data includes the step of presenting the patient data in a final, reportable form.
Claim 10
Dependent Claim
17 words
The method as claimed in claim 9 wherein the patient data are presented for each patient case.
Claim 11
Dependent Claim
22 words
The method as claimed in claim 9 wherein the patient data are presented in aggregate form for the plurality of patient cases.
Claim 12
Dependent Claim
31 words
The method as claimed in claim 1 wherein the step of displaying the at least one message includes the step of displaying the at least one message for each patient case.
Claim 13
Dependent Claim
39 words
The method as claimed in claim 11 wherein the step of displaying the at least one message includes the step of presenting the at least one message for each case in aggregate form for the plurality of patient cases.
Claim 14
Dependent Claim
41 words
The method as claimed in claim 12 further comprising the steps of routing the at least one message to appropriate personnel by comparing the classification results to selection criteria and displaying the at least one message via a system output device.
Claim 15
Dependent Claim
39 words
The method as claimed in claim 14 wherein the at least one message is an alternative message text stored in the data files that is appropriate in orientation, vocabulary, and format to the professional status of the appropriate personnel.
Claim 16
Dependent Claim
31 words
The method as claimed in claim 9 wherein the step of displaying patient data includes the step of displaying messages corresponding to determined misreporting conditions concurrently with the step of presenting.
Claim 17
Dependent Claim
45 words
The method as claimed in claim 1 wherein the data files contain patient data and systems analysis data which includes personnel performance data representing an assessment of trends in personnel efficiency and effectiveness of data correction activities in response to messages routed to appropriate personnel.
Claim 18
Dependent Claim
50 words
The method as claimed in claim 1 wherein the step of storing classification data and review tables in the data files includes the steps of entering and storing user-defined alternatives for diagnosis titles, procedure titles, DRG titles, and DRG cost weights to be accessed at user option in data displays.
Claim 19
Dependent Claim
41 words
The method as claimed in claim 1 wherein the step of determining whether misreporting conditions exist includes the step of determining whether a reporting sequence of the clinical data has resulted in a maximum achievable payment under a DRG-based payment mechanism.
Claim 20
Independent Claim
50 words
The method as claimed in claim wherein the step of determining whether misreporting conditions exist includes the step of determining the likelihood of truthfulness in reporting of claim data for a plurality of patients by quantifying unexploited opportunities to increase payment via the reporting of alternative diagnoses and procedure terms.
Claim 21
Dependent Claim
21 words
The method as claimed in claim 17 further comprising the step of exchanging data with at least one automated data system.
Claim 22
Dependent Claim
48 words
The method as claimed in claim 17 wherein the step of automatically accumulating the aggregate case data and the system analysis data including the personnel performance data includes the step of accumulating summary statistics related to the aggregate case data and the system analysis data across reporting periods.
Claim 23
Independent Claim
45 words
The method as claimed in claim, 17 wherein the step of generating the at least one analysis report includes the step of creating descriptive profiles from the aggregate case data, and system analysis data including the personnel performance data accumulated from a plurality of patients.
Claim 24
Dependent Claim
27 words
The method as claimed in claim 23 further comprising the step of characterizing the quality of patient data as to the type of data quality message generated.
Claim 25
Dependent Claim
32 words
The method as claimed in claim 23 further comprising the step of characterizing problems encountered with respect to the quality of the patient data based on the source of the patient data.
Claim 26
Independent Claim
28 words
The method as claimed in claim, 14 further comprising the step of characterizing the impact of changes in patient data on payments based upon DRG assignments and payments.
Claim 27
Dependent Claim
48 words
The method as claimed in claim 17 wherein the step of generating the at least one analysis report includes the step of creating at least one comparison report from the aggregate case data, and the system analysis data including the personnel performance data from a plurality of patients.
Claim 28
Dependent Claim
33 words
The method as claimed in claim 27 further comprising the step of comparing data contained on the comparison report from a given hospital with data contained on a comparison report from another hospital.
Claim 29
Dependent Claim
42 words
The method as claimed in claim 27 further comprising the step of comparing data contained in the comparison report from a given hospital with averaged data based on the data contained in the group of comparison reports from a group of hospitals.
Claim 30
Dependent Claim
26 words
The method as claimed in claim 27 further comprising the step of comparing data contained in the comparison report from a given hospital with normative data.
Claim 31
Dependent Claim
35 words
The method as claimed in claim 27 further comprising the step of comparing data contained in the comparison report from a given hospital claims payer with data contained in a comparison report of another payer.
Claim 32
Dependent Claim
44 words
The method as claimed in claim 27 further comprising the step of comparing data contained in the comparison report from a given hospital claims payer with average data based in the data contained in a group of comparison reports from a group of payers.
Claim 33
Dependent Claim
44 words
The method as claimed in claim 1 wherein the step of generating at least one analysis report includes the step of creating time trend analyses from aggregated case data, and system analysis data including personnel performance data accummulated in the form of summary statistics.
Claim 34
Dependent Claim
20 words
The method as claimed in claim 33 wherein the time trend analyses include descriptive patient data compared across reporting periods.
Claim 35
Dependent Claim
22 words
The method as claimed in claim 33 wherein the time trend analyses include descriptive profiles of data quality compared across reporting periods.
Claim 36
Dependent Claim
19 words
The method as claimed in claim 33 wherein the time trend analyses include system activities compared across reporting periods.
Claim 37
Dependent Claim
19 words
The method as claimed in claim 33 wherein the time trend analyses include personnel performance compared across reporting periods.
Claim 38
Dependent Claim
25 words
The method as claimed in claim 33 wherein the time trend analyses include changes in payment levels to hospitals by payers compared across reporting periods.
Claim 39
Dependent Claim
30 words
A program storage device readable by a machine, tangibly embodying a program of instructions executable by the machine to perform the method steps of any of claims 1 through 38.
Claim 40
Independent Claim
264 words
A system for automatically detecting, analyzing and classifying patient data reported on a plurality of payment claims, the system comprising: a program of instructions for detecting, analyzing and classifying patient data; a system memory for storing the program of instructions, data files of collections of patient data including patient identifiers and clinical data, misreporting tables and message tables, and classification data and case review tables; a processor coupled to the system memory to carry out the program of instructions for: determining whether misreporting conditions exist in the stored clinical data, the misreporting conditions including actual or potential non-compliance with federally mandated coding and reporting rules and actual or potential failure to properly report complexities of the case; generating at least one data quality message based upon the misreporting tables, the message tables and the determined misreporting conditions; classifying the data quality message generated for each case based upon the classification data, the review tables and the determined misreporting conditions to obtain classification results; automatically accumulating aggregate case data and system analysis data on a plurality of patient cases and storing the aggregate case and system analysis data in system data files; and automatically analyzing the aggregate case data in order to identify patterns of aggregate case data; and a system output device coupled to the processor for: displaying the patient data including the patient identifiers and the clinical data; displaying at least one message based on the determined misreporting conditions in the patient data; and generating at least one analysis report for a plurality of patient cases based upon the analyzed aggregate case data.
Claim 41
Dependent Claim
25 words
The system as claimed in claim 40 wherein a plurality of data quality messages are generated and wherein the processor classifies the data quality messages.
Claim 42
Dependent Claim
18 words
The system as claimed in claim 41 wherein the processor classifies the quality messages in an hierarchical manner.
Claim 43
Dependent Claim
17 words
The system as claimed in claim 40 wherein the processor classifies each case in an hierarchical manner.
Claim 44
Dependent Claim
22 words
The system as claimed in claim 40 wherein the processor classifies each case based on the type of the determined misreporting condition.
Claim 45
Dependent Claim
27 words
The system as claimed in claim 40 wherein the processor classifies data quality messages generated for a case includes determining a probable cause of the misreporting conditions.
Claim 46
Dependent Claim
22 words
The system as claimed in claim 40 wherein the processor classifies each case based on the consequences of the determined misreporting condition.
Claim 47
Dependent Claim
24 words
The system as claimed in claim 40 wherein the processor classifies the data quality messages for a case based on the user-defined prioritization criteria.
Claim 48
Dependent Claim
21 words
The system as claimed in claim 40 wherein the system output device presents the patient data in a final, reportable form.
Claim 49
Dependent Claim
17 words
The system as claimed in claim 48 wherein the patient data are presented for each patient case.
Claim 50
Dependent Claim
22 words
The system as claimed in claim 48 wherein the patient data are presented in aggregate form for the plurality of patient cases.
Claim 51
Dependent Claim
22 words
The system as claimed in claim 40 wherein the system output device displays the at least one message for each patient case.
Claim 52
Independent Claim
30 words
The system as claimed in claim, 50 wherein the system output device presents the at least one message for each case in aggregate form for the plurality of patient cases.
Claim 53
Dependent Claim
43 words
The system as claimed in claim 51 further comprising means for routing the at least one message to appropriate personnel, the means for routing comparing the classification results to selection criteria and wherein the system output device displays the at least one message.
Claim 54
Dependent Claim
39 words
The system as claimed in claim 53 wherein the at least one message is an alternative message text stored in the data files that is appropriate in orientation, vocabulary, and format to the professional status of the appropriate personnel.
Claim 55
Dependent Claim
25 words
The system as claimed in claim 48 wherein the system output device displays messages corresponding to determined misreporting conditions concurrently with presenting the patient data.
Claim 56
Dependent Claim
38 words
The system as claimed in claim 40 wherein the system analysis data includes personnel performance data representing an assessment of trends in personnel efficiency and effectiveness of data correction activities in response to messages routed to appropriate personnel.
Claim 57
Dependent Claim
34 words
The system as claimed in claim 40 wherein the system memory stores user-defined alternatives for diagnosis titles, procedure titles, DRG titles, and DRG cost weights to be accessed at user option in data displays.
Claim 58
Dependent Claim
31 words
The system as claimed in claim 40 wherein the processor determines whether a reporting sequence of the clinical data has resulted in a maximum achievable payment under a DRG-based payment mechanism.
Claim 59
Dependent Claim
41 words
The system as claimed in claim 40 wherein the processor determines the likelihood of truthfulness in reporting of claim data for a plurality of patients by quantifying unexploited opportunities to increase payment via the reporting of alternative diagnoses and procedure terms.
Claim 60
Dependent Claim
19 words
The system as claimed in claim 56 wherein the processor exchanges data with at least one automated data system.
Claim 61
Independent Claim
27 words
The system as claimed in claim, 56 wherein the processor accumulates summary statistics related to the aggregate case data and the system analysis data across reporting periods.
Claim 62
Dependent Claim
33 words
The system as claimed in claim 56 wherein the processor creates descriptive profiles from the aggregate case data, and system analysis data including the personnel performance data accumulated from a plurality of patients.
Claim 63
Dependent Claim
25 words
The system as claimed in claim 62 wherein the processor characterizes the quality of patient data as to the type of data quality message generated.
Claim 64
Dependent Claim
30 words
The system as claimed in claim 62 wherein the processor characterizes problems encountered with respect to the quality of the patient data based on the source of the patient data.
Claim 65
Dependent Claim
26 words
The system as claimed in claim 53 wherein the processor characterizes the impact of changes in patient data on payments based upon DRG assignments and payments.
Claim 66
Dependent Claim
38 words
The system as claimed in claim 56 wherein the system output device creates at least one comparison report from the aggregate case data, and the system analysis data including the personnel performance data from a plurality of patients.
Claim 67
Dependent Claim
31 words
The system as claimed in claim 66 wherein the processor compares data contained on the comparison report from a given hospital with data contained on a comparison report from another hospital.
Claim 68
Dependent Claim
40 words
The system as claimed in claim 66 wherein the processor compares data contained in the comparison report from a given hospital with averaged data based on the data contained in the group of comparison reports from a group of hospitals.
Claim 69
Dependent Claim
24 words
The system as claimed in claim 66 wherein the processor compares data contained in the comparison report from a given hospital with normative data.
Claim 70
Dependent Claim
33 words
The system as claimed in claim 66 wherein the processor compares data contained in the comparison report from a given hospital claims payer with data contained in a comparison report of another payer.
Claim 71
Dependent Claim
42 words
The system as claimed in claim 66 wherein the processor compares data contained in the comparison report from a given hospital claims payer with average data based in the data contained in a group of comparison reports from a group of payers.
Claim 72
Dependent Claim
33 words
The system as claimed in claim 40 wherein the processor creates time trend analyses from aggregated case data, and system analysis data including personnel performance data accummulated in the form of summary statistics.
Claim 73
Dependent Claim
20 words
The system as claimed in claim 72 wherein the time trend analyses include descriptive patient data compared across reporting periods.
Claim 74
Dependent Claim
22 words
The system as claimed in claim 72 wherein the time trend analyses include descriptive profiles of data quality compared across reporting periods.
Claim 75
Dependent Claim
19 words
The system as claimed in claim 72 wherein the time trend analyses include system activities compared across reporting periods.
Claim 76
Dependent Claim
19 words
The system as claimed in claim 72 wherein the time trend analyses include personnel performances compared across reporting periods.
Claim 77
Dependent Claim
25 words
The system as claimed in claim 72 wherein the time trend analyses include changes in payment levels to hospitals by payers compared across reporting periods.
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USPTO Annuity & Maintenance Windows
| Annuity Stage | Window Opens | Payment Deadline | Surcharge Period Until | Estimated Fee | Status |
|---|---|---|---|---|---|
| 3.5 Years (Year 4) | 1997-04-25 | 1997-10-25 | 1998-04-26 | $2000.00 | Window Closed / Lapsed |
| 7.5 Years (Year 8) | 2001-04-25 | 2001-10-25 | 2002-04-26 | $3760.00 | Window Closed / Lapsed |
| 11.5 Years (Year 12) | 2005-04-25 | 2005-10-25 | 2006-04-26 | $7700.00 | Window Closed / Lapsed |