DETAILED ACTION
Status of Claims
This action is in reply to the amendment filed on 12/01/2025.
Claims 1, 5, 7, 9-10 and 16 have been amended.
Claims 2-4, 6, 8, 12, 14-15, 17-19, 24 and 26 have been cancelled.
Claims 1, 5, 7, 9-11, 13, 16, 20-23, 25 and 27 are currently pending and have been examined.
Notice of Pre-AIA or AIA Status
The present application, filed on or after March 16, 2013, is being examined under the first inventor to file provisions of the AIA .
Claim Rejections - 35 USC § 101
35 U.S.C. 101 reads as follows:
Whoever invents or discovers any new and useful process, machine, manufacture, or composition of matter, or any new and useful improvement thereof, may obtain a patent therefor, subject to the conditions and requirements of this title.
Claims 1, 5, 7, 9-11, 13, 16, 20-23, 25 and 27 are rejected under 35 U.S.C. §101 because the claimed invention is directed to an abstract idea without significantly more.
Step 1:
Claims 1, 5-7 and 9 do not squarely fit within non-transitory computer readable medium (i.e., a manufacture) category, due to missing “non-transitory” language mentioned below, claims 10-11, 13, 21-23 and 25 are directed to a method (i.e., a process), and claims 16, 20 and 27 are directed to a system (i.e., a machine). Accordingly, claims 10-11, 13, 16, 20-23, 25 and 27 are all within at least one of the four statutory categories.
Claim 1 is rejected under 35 U.S.C. 101 because the claimed invention is directed to non-statutory subject matter. The claim(s) does/do not fall within at least one of the four categories of patent eligible subject matter because the claim is to a computer storage medium. Where the specification provides support for the claimed element as, a computerized system that includes one or more processors and a non-transitory computer storage medium storing computer-useable instructions., in paragraph 23. The Subject Matter Eligibility of Computer Readable Media memorandum states “The broadest reasonable interpretation of a claim drawn to a computer readable medium . . . typically covers forms of non-transitory tangible media and transitory propagating signal per se . . . particularly when the specification is silent”, Also see MPEP 2106.03(I). It is suggested that Applicant add “non-transitory” to the claimed limitation to overcome the rejection.
Step 2A - Prong One:
An “abstract idea” judicial exception is subject matter that falls within at least one of the following groupings: a) mathematical concepts, b) certain methods of organizing human activity, and/or c) mental processes.
Representative independent claim 16 includes limitations that recite an abstract idea. Note that independent claim 16 is the system claim, while claim 10 covers a method claim and claim 1 covers the matching computer readable medium.
Abstract ideas identified in independent claim 16 underlined:
A computerized system comprising:
one or more processors; and
a non-transitory computer storage media storing computer-useable instructions that, when used by the one or more processors, cause the one or more processors to:
receive, by a revenue cycle management system through network communications, encounter information for a patient encounter that has missing information that will cause rejection of a claim corresponding to the patient encounter;
receive, through the network communications from a clinical computer system at the revenue cycle management system, a status order to admit a patient to inpatient during the patient encounter;
generate, on a first user device that is associated with a treating clinician of the patient encounter a display of the encounter information that lacks the missing registration information in a graphical user interface;
generate, on the first user device, a display for entry of the status order;
prompt, on the first user device associated with a treating clinician of the patient encounter, that the status order cannot be completed because of the missing registration information;
accept entry of the status order as a planned status order through the graphical user interface;
cause an alert, at the clinical computer system, to register the patient:
monitor, at the revenue cycle management system through the network communications, the clinical computer system to identify arrival of the missing registration information through a second user device that is associated with a user other than the treating clinician,
receive, at the revenue cycle management system through the network communications, from the clinical computer system, the missing registration information;
synchronize, at the revenue cycle management system, the encounter information with the missing registration information in the revenue cycle management system by automatically editing the encounter information to include the missing registration and information from the planned service order to, enable the claim corresponding to the patient encounter to be accepted for billing; and
automatically update the display of the encounter information on the first user device with the synchronized encounter information.
The Examiner submits that the foregoing underlined limitations constitute(a) “certain methods of organizing human activity” because identifying missing information that prevents a medical billing claim from being processed by prompting a clinician to pay attention to necessary corrections needed to complete processing of the medical billing claim and a revenue cycle and managing a inpatient process where a patient is in observation, admittance and discharge phases all are providing clinical and administrative health care services and relate to managing human behavior/interactions between people. Furthermore, the foregoing underlined limitations constitute (b) “a mental process” because paying attention to missing information, needing corrections are observations/evaluations/analysis that can be performed in the human mind or with a pen and paper. The foregoing underlined limitations also relate to claims 1 and 10 (similarly to claim 16).
Accordingly, the claim describes at least one abstract idea.
In relation to claims 5, 7, 11 and 13, these claims merely recite specific kinds of information such as such as missing information, a mismatch in data corresponding to the order, registration information as mismatch in a day or a time corresponding to the order or a mismatch in a setting corresponding to the order and settings comprising inpatient, outpatient, observation, discharge, or clinical discharge. Claims 9, 20-23 and 25 recites determining steps such as converting the order into the planned order that prompts the clinician for the missing information, communicating an alert that indicates why the order cannot be completed, editing conversions from nonstandard to standard format, converting a planned order to place the patient in observation to inpatient care, obtaining missing information, displaying updates from entry of the status order and co-signing a discharge order and displaying the encounter information that has missing information, associated with the treating clinician of the patient encounter, the treating clinician may enter the missing information and following the synchronizing, and updating the encounter information to include the missing information.
Step 2A - Prong Two:
Regarding Prong Two of Step 2A, it must be determined whether the claim as a whole integrates the abstract idea into a practical application. As noted, it must be determined whether any additional elements in the claim beyond the abstract idea integrate the exception into a practical application in a manner that imposes a meaningful limit on the judicial exception. The courts have indicated that additional elements merely using a computer to implement an abstract idea, adding insignificant extra solution activity, or generally linking use of a judicial exception to a particular technological environment or field of use do not integrate a judicial exception into a “practical application.”
The limitations of claims 1, 10 and 16, as drafted is a process that, under its broadest reasonable interpretation, covers performance of the limitations in the human mind but for the recitation of generic computer components. That is, other than reciting one or more processors, a clinician system, a graphical user interface, a revenue cycle management system and a non-transitory computer storage media storing computer-useable instructions to perform the limitations, nothing in the claim elements precludes the steps from practically being performed in the human mind. If a claim limitation, under its broadest reasonable interpretation, covers performance of the limitation within a health care environment in the human mind but for the recitation of generic computer components, then it falls within the “certain methods of organizing human activity” and “Mental Process” grouping of abstract ideas. Accordingly, the claims recite an abstract idea.
The judicial exception is not integrated into a practical application. In particular, the one or more processors, clinician system, graphical user interface, revenue cycle management system and non-transitory computer storage media storing computer-useable instructions are recited at high levels of generality (i.e., as generic computer components performing generic computer functions of receiving data/inputs, determining and providing data) such that it amounts no more than mere instructions to apply the exception using the generic computer components.
Regarding the additional limitation “receive, by a revenue cycle management system through network communications, encounter information for a patient encounter that has missing information that will cause rejection of a claim corresponding to the patient encounter” and “receive, through the network communications from a clinical computer system at the revenue cycle management system, a status order to admit a patient to inpatient during the patient encounter,” the Examiner submits that this additional limitation merely adds insignificant pre-solution activity (data gathering; selecting data to be manipulated) to the at least one abstract idea (see MPEP § 2106.05(g)).
Thus, taken alone, the additional elements do not amount to significantly more than the above identified judicial exception (the abstract idea). Looking at the limitations as an ordered combination add nothing that is not already present when looking at the elements taken individually. For instance, there is no indication that the additional elements, when considered as a whole, reflect an improvements in the functioning of a computer or an improvement to another technology or technical field, apply or us the above-noted implement/use to above-noted judicial exception with a particular machine or manufacture that is integral to the claim, effect a transformation or reduction of a particular article to a different state or thing, or apply or use the judicial exception in some meaningful way beyond generally linking the use of the judicial exception to a particular technological environment, such that the claim as a whole is not more than a drafting effort designed to monopolize the exception (see MPEP §2106.05). Their collective functions merely provide conventional computer implementation.
The claims do not include additional elements that are sufficient to amount to significantly more than the judicial exception. As discussed above with respect to the integration of the abstract idea into practical application, the additional elements amount to no more than mere instructions to apply the exception using generic computer components. Mere instructions to apply an exception using generic computer component provide an inventive concept. The claims are not patent eligible.
Step 2B:
Regarding Step 2B, in representative independent claim 16, regarding the additional limitations of the one or more processors, clinician system, graphical user interface, revenue cycle management system and non-transitory computer storage media storing computer-useable instructions, the Examiner submits that these limitations amount to merely using a computer to perform the at least one abstract idea (see MPEP § 2106.05(f)).
Thus, representative independent claim 16 and analogous independent claims 1 and 10 do not include additional elements (considered both individually and as an ordered combination) that are sufficient to amount to significantly more than the judicial exception for the same reasons to those discussed above with respect to determining that the claim does not integrate the abstract idea into a practical application.
The dependent claims do not include additional elements (considered both individually and as an ordered combination) that are sufficient to amount to significantly more than the judicial exception for the same reason discussed above with respect to determining that the dependent claims do not integrate the at least abstract idea into a practical application.
Therefore, claims 1, 5, 7, 9-11, 13, 16, 20-23, 25 and 27 are ineligible under 35 USC §101.
Claim Rejections - 35 USC § 103
The following is a quotation of 35 U.S.C. 103 which forms the basis for all obviousness rejections set forth in this Office action:
A patent for a claimed invention may not be obtained, notwithstanding that the claimed invention is not identically disclosed as set forth in section 102, if the differences between the claimed invention and the prior art are such that the claimed invention as a whole would have been obvious before the effective filing date of the claimed invention to a person having ordinary skill in the art to which the claimed invention pertains. Patentability shall not be negated by the manner in which the invention was made.
The factual inquiries for establishing a background for determining obviousness under 35 U.S.C. 103 are summarized as follows:
1. Determining the scope and contents of the prior art.
2. Ascertaining the differences between the prior art and the claims at issue.
3. Resolving the level of ordinary skill in the pertinent art.
4. Considering objective evidence present in the application indicating obviousness or nonobviousness.
Claims 1, 5, 7, 9-11, 13, 16, 20-21 and 23 are rejected under 35 U.S.C. 103 as being unpatentable over Fitzgerald (US 7,917,378 B2) in view of Stoudt (US 2007/0130111 A1) further in view of Walker (US 2020/0019946 A1).
Claim 1:
Fitzgerald discloses one or more non-transitory computer storage media having computer-executable instructions embodied thereon, that when executed, perform operations (See software applications and executable procedure in column 3, line 64 to column 4, line 10.), the operations comprising:
receiving, by a revenue cycle management system through network communications, encounter information for a patient encounter that has missing registration information that will cause rejection of a claim corresponding to the patient encounter (See Fig. 1 the system uses to correct claims errors in revenue cycle, adjudication process in [column 3, lines 18-63] The FIG. 1 system automates the pre-registration, eligibility, registration authorization, claim generation, trial adjudication, claim submission, payment remittance, and post-remittance processes of a health care claim data processing cycle to provide seamless, accurate and prompt processing. Also, see missing data in the revenue cycle, adjudication process in column 11, lines 4-51.);
receiving, through the network communications from a clinical computer system at the revenue cycle management system, a status order to admit the patient to inpatient (Besides requesting for information, issue remittance advice, obtaining worklists and reports in the adjudication process, column 8, lines 10-26, see patient encounters include inpatient stay (column 4, lines 29-41) exemplary in [column 11, lines 24-35] Rule 719 detects and warns of invalid inpatient revenue codes, missing valid codes.);
generating, on a first user device that is associated with a treating clinician of the patient encounter a display of the encounter information that lacks the missing registration information in a graphical user interface (By lacking any missing data in the revenue cycle, adjudication process, including registration information (column 3, lines 18-63) and the registration information as data collected in the beginning of the patient’s encounter, Fitzgerald’s Fig. 7 shows a list of various error codes indicative of errors that did not occur in the beginning of the patient’s encounter, such as exemplary error code “SA0157, OC DT GT ADMDT…. – BECAUSE THE OCCURANCE DATE ASSOCIATED WITH OCCURANCE CODE 41 IS GREATER THAN (GT)” , where the occurrence data entered falls after the admission date mentioned in column 11, lines 13-35.);
generating, on the first user device, a display for entry of the status order (See Fig. 4- Fig. 6 display screens include list of current error codes mentioned in column 11, lines 36-51.);
prompting, on the first user device that the status order cannot be completed because of the missing registration information (Besides listing claim rejection reasons in column 11, lines 45-51, see column 11, lines 57-67 where an alert is generated when a claim is identified as deficient and [column 6, lines 4-13] Rule Checker unit 50 monitors rules in repository 74 and identifies and indicates to a user those rules that are incomplete or contain incorrect syntax.);
monitoring at the revenue cycle management system through the network communications, the clinical computer system for entry of the missing registration information (With a listen component as monitoring a revenue cycle, see applying validation rules of the revenue cycle for missing data mentioned in column 11, lines 36-51. Also, see [column 8, lines10-26] A payer is further able to communicate a request for information or issue remittance advice and obtain worklists and reports and manage its business and revenue cycle.) through a second user device that is associated with a user other than the treating clinician (See column 7, lines 18-32, Fig. 1 item 30 interface from multiple source users such as participants, providers, payers, consumers, employers and the government.);
receiving at the revenue cycle management system through the network communications, from the clinical computer system, the missing registration information (Taught in column 11, lines 36-51, Fig. 6 where reasons for claim rejection reasons are received in a list which includes missing name portion and omission of accommodation data and ancillary data. Also, see column 12, lines 5-9, where the received claim is automatically or manually edited to provide amended claim data.);
synchronizing, at the revenue cycle management system, the encounter information with the missing registration information in the revenue cycle management system by automatically editing the encounter information to include the missing registration and information from the planned service order to, enable the claim corresponding to the patient encounter to be accepted for billing (Automatically resolving claim data by adding missing data (column 11, lines 4-35) construes synchronizing automated edits that enable the claim corresponding to the patient encounter to be accepted for billing.).
Although Fitzgerald discloses a revenue cycle management system synchronizing encounter information that lacks missing and missing registration information as mentioned above, Fitzgerald does not explicitly teach when the GUI causes alert to register the patient after entered status inquiry and automatically updating the display of the encounter information. Stoudt teaches:
accepting entry of the status order as a planned status order through the graphical user interface (See Fig. 3, steps 3010, 3030 and 3040 mentioned in P0029, see Fig. 5 claim status inquiry for submission.);
causing an alert, at the clinical computer system, to register the patient (With the registration information as data collected in the beginning of the patient’s encounter, see P0027 where a claim status request triggers initiating platforms to register the patient such as a revenue cycle activity, updating a status of an account, prompting a user for additional information, generating of reports, or generating follow-up information.); and
automatically updating the display of the encounter information on the first user device with the synchronized encounter information (See Fig. 6 claim status inquiry response include fields for data that can be re-gathered such as patient name, request date, a payer claim number, dates of the statement, a claim status code category, claim status codes, a claim charge amount, a claim payment amount, a status information effective date, an adjudication date, a payment method code, a check issue date or electronic funds transfer effective date, and a check number or electronic funds transfer trace number. mentioned in P0039.).
Therefore, it would have been obvious to one of ordinary skill in the art of claim status management before the effective filing date of the claimed invention to modify the system and method of Fitzgerald, when the GUI causes alert to register the patient after entered status inquiry and automatically updating the display of the encounter information as taught by Stoudt in order to support reporting for multi-entity organizations or reporting on claims status that correlates different revenue cycle transactions associated with an episode of care mentioned in Stoudt’s P0008.
Although Fitzgerald and Stoudt teach a revenue cycle management system, method and software for synchronizing encounter information that lacks missing and missing registration information, when the GUI causes alert to register the patient after entered status inquiry and automatically updating the display of the encounter information as mentioned above Fitzgerald and Stoudt do not explicitly teach placing the patient in a virtual unit while waiting for missing registration information and replacing values in the encounter information with corresponding values. Walker teaches:
placing, at the revenue cycle management system, the patient in a virtual unit and storing the status order as a temporary planned status order that is not billable until registration information is received, wherein the planned status order is received during the patient encounter before full registration is completed and remains pending in the virtual unit until the missing registration information is subsequently received (See patient user in P0013, P0028 answering the patient’s billing questions via chat, computers, software and servers as virtualized machines mentioned in P0050 with screen capture features shown in Fig. 3, P0116. Also, see [P0022-P0023] The software also includes a communications module which generates a bill communication for the user to transmit the bill to the user and further modifying a content of the bill communication based on the one or more codes to request information from the user if the one or more codes indicate that patient data from the user is missing which could modify the bill.).
wherein the synchronizing includes automatically replacing values in the encounter information with corresponding values from the temporary planned status order, including at least one of: bed transfer information, patient type, accommodation, medical service, admitting physician, or attending physician (Besides updating changed billing code in P0022-P0023, see variable replacement fields such as the names, dates, or locations mentioned in P0119.).
Therefore, it would have been obvious to one of ordinary skill in the art of intelligent patient billing before the effective filing date of the claimed invention to modify the system and method of Fitzgerald and Stoudt to include placing the patient in a virtual unit while waiting for missing registration information and replacing values in the encounter information with corresponding values as taught by Walker when the patient gives up waiting online to talk with their insurance company, or any number of similar situations mentioned in Stoudt’s P0086.
Regarding claim 9, although Fitzgerald, Stoudt and Walker teach the non-transitory computer storage media of claim 1 mentioned above, Fitzgerald discloses further comprising communicating an alert through the network communications to the clinical computer system, that indicates why the status order cannot be completed (See Fig. 1, column 3, lines 18-40 the system uses to shortened revenue cycle, column 8, lines 10-26 in adjudication process and Fig. 6, [column 11, lines 36-51] The results list identifies 7 claim rejection reasons comprising, an invalid revenue code (602), a data format deficiency (607), a missing name portion (609), an accommodation data omission (611), a revenue code related error (613), a procedure code related error (615) and accommodation or ancillary data omission (617).)
Claim 10:
Fitzgerald discloses a computerized method comprising:
receiving, by a revenue cycle management system through network communications, encounter information for a patient encounter that has missing registration information that will cause rejection of a claim corresponding to the patient encounter (See Fig. 1 the system uses to correct claims errors in revenue cycle, adjudication process in [column 3, lines 18-63] The FIG. 1 system automates the pre-registration, eligibility, registration authorization, claim generation, trial adjudication, claim submission, payment remittance, and post-remittance processes of a health care claim data processing cycle to provide seamless, accurate and prompt processing. Also, see missing data in the revenue cycle, adjudication process in column 11, lines 4-51.);
receiving through the network communications from a clinical computer system at the revenue cycle management system, a status order to admit a patient to inpatient (Besides requesting for information, issue remittance advice, obtaining worklists and reports in the adjudication process, column 8, lines 10-26, see patient encounters include inpatient stay (column 4, lines 29-41) exemplary in [column 11, lines 24-35] Rule 719 detects and warns of invalid inpatient revenue codes, missing valid codes. See Fig 7 show an exemplary list of various error codes include invalid inpatient revenue code, such as “SA0152, INVALID I/P REVCD” , mentioned in column 11, lines 24-35.);
generate, on a first user device that is associated with a treating clinician of the patient encounter a display of the encounter information that lacks the missing registration information in a graphical user interface (By lacking any missing data in the revenue cycle, adjudication process, including registration information (column 3, lines 18-63) and the registration information as data collected in the beginning of the patient’s encounter, Fitzgerald’s Fig. 7 shows a list of various error codes indicative of errors that did not occur in the beginning of the patient’s encounter, such as exemplary error code “SA0157, OC DT GT ADMDT…. – BECAUSE THE OCCURANCE DATE ASSOCIATED WITH OCCURANCE CODE 41 IS GREATER THAN (GT)” , where the occurrence data entered falls after the admission date mentioned in column 11, lines 13-35.);
generate, on the first user device, a display for entry of the status order (See Fig. 4- Fig. 6 display screens include list of current error codes mentioned in column 11, lines 36-51.);
causing a treating clinician of the patient encounter to be prompted, on the first user device associated with the clinician, wherein the prompt indicates that the status order cannot be completed because of the missing information (Besides listing claim rejection reasons in column 11, lines 45-51, see column 11, lines 57-67 where an alert is generated when a claim is identified as deficient and [column 6, lines 4-13] Rule Checker unit 50 monitors rules in repository 74 and identifies and indicates to a user those rules that are incomplete or contain incorrect syntax.);
monitoring, at the revenue cycle management system through the network communications, one or more clinical computer systems that includes the clinical computer system for receipt of the missing registration information (With a listen component as monitoring a revenue cycle, see applying validation rules of the revenue cycle for missing data mentioned in column 11, lines 36-51. Also, see [column 8, lines10-26] A payer is further able to communicate a request for information or issue remittance advice and obtain worklists and reports and manage its business and revenue cycle.) through a second user device that is associated with a user other than the treating clinician (See column 7, lines 18-32, Fig. 1 item 30 interface from multiple source users such as participants, providers, payers, consumers, employers and the government.);
receiving, at the revenue cycle management system through the network communications, from the one or more clinical systems, the missing registration information (Taught in column 11, lines 36-51, Fig. 6 where reasons for claim rejection reasons are received in a list which includes missing name portion and omission of accommodation data and ancillary data. Also, see column 12, lines 5-9, where the received claim is automatically or manually edited to provide amended claim data.);
synchronizing, at the revenue cycle management system, the encounter information with the missing registration information in the revenue cycle management system by automatically editing the encounter information to include the missing registration and information from the planned service order to, enable the claim corresponding to the patient encounter to be accepted for billing (Automatically resolving claim data by adding missing data (column 11, lines 4-35) construes synchronizing automated edits that enable the claim corresponding to the patient encounter to be accepted for billing.).
Although Fitzgerald discloses a revenue cycle management system synchronizing encounter information that lacks missing and missing registration information as mentioned above, Fitzgerald does not explicitly teach when the GUI causes alert to register the patient after entered status inquiry and automatically updating the display of the encounter information. Stoudt teaches:
accepting entry of the status order as a planned status order through the graphical user interface (See Fig. 3, steps 3010, 3030 and 3040 mentioned in P0029, see Fig. 5 claim status inquiry for submission.);
causing an alert, at the clinical computer system, to register the patient (With the registration information as data collected in the beginning of the patient’s encounter, see P0027 where a claim status request triggers initiating platforms to register the patient such as a revenue cycle activity, updating a status of an account, prompting a user for additional information, generating of reports, or generating follow-up information.); and
automatically updating the display of the encounter information on the first user device with the synchronized encounter information (See Fig. 6 claim status inquiry response include fields for data that can be re-gathered such as patient name, request date, a payer claim number, dates of the statement, a claim status code category, claim status codes, a claim charge amount, a claim payment amount, a status information effective date, an adjudication date, a payment method code, a check issue date or electronic funds transfer effective date, and a check number or electronic funds transfer trace number. mentioned in P0039.).
Therefore, it would have been obvious to one of ordinary skill in the art of claim status management before the effective filing date of the claimed invention to modify the system and method of Fitzgerald, when the GUI causes alert to register the patient after entered status inquiry and automatically updating the display of the encounter information as taught by Stoudt in order to support reporting for multi-entity organizations or reporting on claims status that correlates different revenue cycle transactions associated with an episode of care mentioned in Stoudt’s P0008.
Although Fitzgerald and Stoudt teach a revenue cycle management system, method and software for synchronizing encounter information that lacks missing and missing registration information, when the GUI causes alert to register the patient after entered status inquiry and automatically updating the display of the encounter information as mentioned above Fitzgerald and Stoudt do not explicitly teach placing the patient in a virtual unit while waiting for missing registration information and replacing values in the encounter information with corresponding values. Walker teaches:
placing, at the revenue cycle management system, the patient in a virtual unit and storing the status order as a temporary planned status order that is not billable until registration information is received, wherein the planned status order is received during the patient encounter before full registration is completed and remains pending in the virtual unit until the missing registration information is subsequently received (See patient user in P0013, P0028 answering the patient’s billing questions via chat, computers, software and servers as virtualized machines mentioned in P0050 with screen capture features shown in Fig. 3, P0116. Also, see [P0022-P0023] The software also includes a communications module which generates a bill communication for the user to transmit the bill to the user and further modifying a content of the bill communication based on the one or more codes to request information from the user if the one or more codes indicate that patient data from the user is missing which could modify the bill.).
wherein the synchronizing includes automatically replacing values in the encounter information with corresponding values from the temporary planned status order (Besides updating changed billing code in P0022-P0023, see variable replacement fields such as the names, dates, or locations mentioned in P0119.).
Therefore, it would have been obvious to one of ordinary skill in the art of intelligent patient billing before the effective filing date of the claimed invention to modify the system and method of Fitzgerald and Stoudt to include placing the patient in a virtual unit while waiting for missing registration information and replacing values in the encounter information with corresponding values as taught by Walker when the patient gives up waiting online to talk with their insurance company, or any number of similar situations mentioned in Stoudt’s P0086.
Claim 16:
Fitzgerald discloses computerized system comprising:
one or more processors (See computer systems in column 3, line 64 to column 4, line 10.); and
a non-transitory computer storage media storing computer-useable instructions that, when used by the one or more processors, cause the one or more processors (See software applications and executable procedure in column 3, line 64 to column 4, line 10.) to:
receive, by a revenue cycle management system through network communications, encounter information for a patient encounter that has missing information that will cause rejection of a claim corresponding to the patient encounter (See Fig. 1, column 3, lines 18-40 the system uses to shortened revenue cycle, column 8, lines 10-26 in adjudication process and Fig. 6, [column 11, lines 36-51] The results list identifies 7 claim rejection reasons comprising, an invalid revenue code (602), a data format deficiency (607), a missing name portion (609), an accommodation data omission (611), a revenue code related error (613), a procedure code related error (615) and accommodation or ancillary data omission (617). Also, see missing data in column 11, lines 30-35.);
receive, through the network communications from a clinical computer system at the revenue cycle management system, a status order for a patient during the patient encounter, wherein the status order is one of an order to admit the patient to inpatient, place the patient in observation, or discharge the patient (Besides requesting for information, issue remittance advice, obtaining worklists and reports in the adjudication process, column 8, lines 10-26, see patient encounters include inpatient stay (column 4, lines 29-41) exemplary in [column 11, lines 24-35] Rule 719 detects and warns of invalid inpatient revenue codes, missing valid codes.);
generate, on a first user device that is associated with a treating clinician of the patient encounter a display of the encounter information that lacks the missing registration information in a graphical user interface (By lacking any missing data in the revenue cycle, adjudication process, including registration information (column 3, lines 18-63) and the registration information as data collected in the beginning of the patient’s encounter, Fitzgerald’s Fig. 7 shows a list of various error codes indicative of errors that did not occur in the beginning of the patient’s encounter, such as exemplary error code “SA0157, OC DT GT ADMDT…. – BECAUSE THE OCCURANCE DATE ASSOCIATED WITH OCCURANCE CODE 41 IS GREATER THAN (GT)” , where the occurrence data entered falls after the admission date mentioned in column 11, lines 13-35.);
generate, on the first user device, a display for entry of the status order (See Fig. 4- Fig. 6 display screens include list of current error codes mentioned in column 11, lines 36-51.);
prompt, on the first user device associated with a treating clinician of the patient encounter, that the status order cannot be completed because of the missing registration information (Besides listing claim rejection reasons in column 11, lines 45-51, see column 11, lines 57-67 where an alert is generated when a claim is identified as deficient and [column 6, lines 4-13] Rule Checker unit 50 monitors rules in repository 74 and identifies and indicates to a user those rules that are incomplete or contain incorrect syntax.);
monitor, at the revenue cycle management system through the network communications, the clinical computer system to identify arrival of the missing registration information (With a listen component as monitoring a revenue cycle, see applying validation rules of the revenue cycle for missing data mentioned in column 11, lines 36-51. Also, see [column 8, lines10-26] A payer is further able to communicate a request for information or issue remittance advice and obtain worklists and reports and manage its business and revenue cycle.) through a second user device that is associated with a user other than the treating clinician (See column 7, lines 18-32, Fig. 1 item 30 interface from multiple source users such as participants, providers, payers, consumers, employers and the government.);
receive, at the revenue cycle management system through the network communications, from the clinical computer system, the missing registration information (Taught in column 11, lines 36-51, Fig. 6 where reasons for claim rejection reasons are received in a list which includes missing name portion and omission of accommodation data and ancillary data. Also, see column 12, lines 5-9, where the received claim is automatically or manually edited to provide amended claim data.);
synchronize, at the revenue cycle management system, the encounter information with the missing registration information in the revenue cycle management system by automatically editing the encounter information to include the missing registration and information from the planned service order to, enable the claim corresponding to the patient encounter to be accepted for billing (Automatically resolving claim data by adding missing data (column 11, lines 4-35) construes synchronizing automated edits that enable the claim corresponding to the patient encounter to be accepted for billing.).
Although Fitzgerald discloses a revenue cycle management system synchronizing encounter information that lacks missing and missing registration information as mentioned above, Fitzgerald does not explicitly teach when the GUI causes alert to register the patient after entered status inquiry and automatically updating the display of the encounter information. Stoudt teaches:
accept entry of the status order as a planned status order through the graphical user interface (See Fig. 3, steps 3010, 3030 and 3040 mentioned in P0029, see Fig. 5 claim status inquiry for submission.);
cause an alert, at the clinical computer system, to register the patient (With the registration information as data collected in the beginning of the patient’s encounter, see P0027 where a claim status request triggers initiating platforms to register the patient such as a revenue cycle activity, updating a status of an account, prompting a user for additional information, generating of reports, or generating follow-up information.); and
automatically update the display of the encounter information on the first user device with the synchronized encounter information (See Fig. 6 claim status inquiry response include fields for data that can be re-gathered such as patient name, request date, a payer claim number, dates of the statement, a claim status code category, claim status codes, a claim charge amount, a claim payment amount, a status information effective date, an adjudication date, a payment method code, a check issue date or electronic funds transfer effective date, and a check number or electronic funds transfer trace number. mentioned in P0039.).
Therefore, it would have been obvious to one of ordinary skill in the art of claim status management before the effective filing date of the claimed invention to modify the system and method of Fitzgerald, when the GUI causes alert to register the patient after entered status inquiry and automatically updating the display of the encounter information as taught by Stoudt in order to support reporting for multi-entity organizations or reporting on claims status that correlates different revenue cycle transactions associated with an episode of care mentioned in Stoudt’s P0008.
Although Fitzgerald and Stoudt teach a revenue cycle management system, method and software for synchronizing encounter information that lacks missing and missing registration information, when the GUI causes alert to register the patient after entered status inquiry and automatically updating the display of the encounter information as mentioned above Fitzgerald and Stoudt do not explicitly teach placing the patient in a virtual unit while waiting for missing registration information and replacing values in the encounter information with corresponding values. Walker teaches:
place, at the revenue cycle management system, the patient in a virtual unit and storing the status order as a temporary planned status order that is not billable until registration information is received, wherein the planned status order is received during the patient encounter before full registration is completed and remains pending in the virtual unit until the missing registration information is subsequently received (See patient user in P0013, P0028 answering the patient’s billing questions via chat, computers, software and servers as virtualized machines mentioned in P0050 with screen capture features shown in Fig. 3, P0116. Also, see [P0022-P0023] The software also includes a communications module which generates a bill communication for the user to transmit the bill to the user and further modifying a content of the bill communication based on the one or more codes to request information from the user if the one or more codes indicate that patient data from the user is missing which could modify the bill.).
wherein the synchronizing includes automatically replacing values in the encounter information with corresponding values from the temporary planned status order (Besides updating changed billing code in P0022-P0023, see variable replacement fields such as the names, dates, or locations mentioned in P0119.).
Therefore, it would have been obvious to one of ordinary skill in the art of intelligent patient billing before the effective filing date of the claimed invention to modify the system and method of Fitzgerald and Stoudt to include placing the patient in a virtual unit while waiting for missing registration information and replacing values in the encounter information with corresponding values as taught by Walker when the patient gives up waiting online to talk with their insurance company, or any number of similar situations mentioned in Stoudt’s P0086.
Regarding claim 5, although Fitzgerald, Stoudt and Walker teach the non-transitory computer storage media of claim 1 mentioned above, Fitzgerald discloses further comprising a mismatch in data corresponding to the order (See column 10 lines 60-66 and column 11 line 13-29 where finding conflicts or inconsistencies, (e.g., mismatches) in claim data fields are found, such as conflicts in date, diagnoses, etc.).
Regarding claim 7, although Fitzgerald, Stoudt and Walker teach the non-transitory computer storage media of claim 5 mentioned above, Fitzgerald discloses wherein the mismatch in data corresponding to the order comprises a mismatch in a day or a time corresponding to the order or a mismatch in a setting corresponding to the order (See finding conflicts or inconsistencies (i.e. mismatches) in claim data fields, such as conflicts in date in [column 11, lines 13-29] Rules 703 and 705 detect and generate a warning if a date of a service provided to a patient conflicts with prescribed reimbursement date ranges….Similarly, rule 709 identifies and generates a warning for an invalid patient admission date and rule 717 identifies and generates a warning if an occurrence (e.g., an injury) date falls after an admission date”.)
Regarding claim 11, Fitzgerald discloses wherein the encounter information further includes a mismatch in data corresponding to the status order (See finding conflicts or inconsistencies (i.e. mismatches) in claim data fields, such as conflicts in date in [column 11, lines 13-29] Rules 703 and 705 detect and generate a warning if a date of a service provided to a patient conflicts with prescribed reimbursement date ranges….Similarly, rule 709 identifies and generates a warning for an invalid patient admission date and rule 717 identifies and generates a warning if an occurrence (e.g., an injury) date falls after an admission date”.).
Regarding claim 13, Fitzgerald discloses wherein the mismatch in the data corresponding to the status order comprises a first mismatch in a day or a time corresponding to the status order or a second mismatch in a setting corresponding to the status order (See finding conflicts or inconsistencies (i.e. mismatches) in claim data fields, such as conflicts in date in [column 11, lines 13-29] Rules 703 and 705 detect and generate a warning if a date of a service provided to a patient conflicts with prescribed reimbursement date ranges….Similarly, rule 709 identifies and generates a warning for an invalid patient admission date and rule 717 identifies and generates a warning if an occurrence (e.g., an injury) date falls after an admission date”.)
Regarding claim 20, Fitzgerald discloses further comprising communicating an alert through the network communications to the clinical computer system, that indicates why the status order cannot be completed (See Fig. 1, column 3, lines 18-40 the system uses to shortened revenue cycle, column 8, lines 10-26 in adjudication process and Fig. 6, [column 11, lines 36-51] The results list identifies 7 claim rejection reasons comprising, an invalid revenue code (602), a data format deficiency (607), a missing name portion (609), an accommodation data omission (611), a revenue code related error (613), a procedure code related error (615) and accommodation or ancillary data omission (617).).
Regarding claim 21, Fitzgerald discloses wherein: the missing information causes the encounter information to have a non- standard format in the one or more clinical computer systems; and the automated edits convert the encounter information into a standardized format at the revenue cycle management system (With a claim with missing information as non-standard format converted to a standard format by adding the missing information, see column 11, lines 36-51, identifying claims with missing or conflicting information (i.e. a claim in “non-standard” format) and amending the claim with new information (i.e. converting the claim to a “standard” format.).
Regarding claim 23, Fitzgerald discloses further comprising: accepting the encounter information during creation of a preadmit encounter; in response to the status order being to admit the patient to inpatient (See automated pre-registration and registration authorization in column 3, lines 18-22.), converting the status order into a planned order to admit the patient to inpatient and performing the prompting (See detecting invalid inpatient revenue codes in column 11, lines 18-33.); and performing the synchronizing in response to full registration of the patient, wherein the synchronizing obtains the missing information from the planned order (Automatically resolving claim data by adding missing data (column 11, lines 4-35) construes synchronizing automated edits that enable the claim corresponding to the patient encounter to be accepted for billing.).
Claims 22 and 25 are rejected under 35 U.S.C. 103 as being unpatentable over Fitzgerald (US 7,917,378 B2) in view of Stoudt (US 2007/030111 A1) further in view of Walker (US 2020/0019946 A1) and Gonzales (US 11,348,689 B1).
Regarding claim 22, although Fitzgerald discloses the method of claim 10 as mentioned above, Fitzgerald, Stoudt and Walker do not explicitly teach in response to the status order being to place the patient in observation, converting, at the revenue cycle management system, the status order into a planned order to place the patient in observation and performing the prompting, further status order for the patient during the patient encounter to admit the patient to inpatient and performing the synchronizing in response to the further status order. Gonzales teaches further comprising: in response to the status order being to place the patient in observation, converting, at the revenue cycle management system, the status order into a planned order to place the patient in observation and performing the prompting (See status of patient in column 18, lines12-35, when relating to the transfer of a patient.); receiving a further status order for the patient during the patient encounter to admit the patient to inpatient; and performing the synchronizing in response to the further status order, wherein the synchronizing obtains the missing information from the further status order (Also, see revenue report in column 9, lines 12-21. See column 14, lines 24-41, where the creation of a new record is based on the patient’s status of being admitted into a particular hospital facility, a surrounding hospital facility, or any other related hospital facility.).
Therefore, it would have been obvious to one of ordinary skill in the art of standardized medical management before the effective filing date of the claimed invention to modify the system and method of Fitzgerald, Stoudt and Walker to include in response to the status order being to place the patient in observation, converting, at the revenue cycle management system, the status order into a planned order to place the patient in observation and performing the prompting, further status order for the patient during the patient encounter to admit the patient to inpatient and performing the synchronizing in response to the further status order as taught by Gonzales in order to have a consistent format throughout that hospital facility, other medical providers, physicians and hospital facilities when using a different format for medical records mentioned in column 1, lines 21-28.
Regarding claim 25, although Fitzgerald, Stoudt and Walker teach the method of claim 10 as mentioned above, Fitzgerald, Stoudt and Walker do not explicitly teach a discharge status order, co-signing of the discharge order and it’s cancellation. Gonzales teaches wherein the status order is a discharge order to discharge the patient, the method further comprising: determining that proper co-signing of the discharge order is second missing information; and prompting, on the first user device associated with the treating clinician of the patient encounter, that the discharge order has not been properly co- signed and that the discharge order will be cancelled (See column 18, lines 12-35, where quick entry protocols supporting admission and discharging patients allow for sending transfer notifications among doctor, physician or hospitalist to co-sign. See Fig. 8C, where highlighted patient data can be cancelled or updated.).
Therefore, it would have been obvious to one of ordinary skill in the art of standardized medical management before the effective filing date of the claimed invention to modify the system and method of Fitzgerald, Stoudt and Walker to include a discharge status order, co-signing of the discharge order and it’s cancellation as taught by Gonzales in order to have a consistent format throughout that hospital facility, other medical providers, physicians and hospital facilities when using a different format for medical records mentioned in column 1, lines 21-28.
Claim 27 is rejected under 35 U.S.C. 103 as being unpatentable over Fitzgerald (US 7,917,378 B2) in view of Stoudt (US 2007/0130111 A1) further in view of Walker (US 2020/0019946 A1) and Spencer (US 2016/0374776 A1).
Regarding claim 27, although Fitzgerald and Stoudt teach the computerized system of claim 16, wherein the computer-useable instructions of Fitzgerald, Stoudt and Walker mentioned above, Fitzgerald, Stoudt and Walker do not explicitly teach detecting the location of a patient associated inpatient and trigger a generation that the patient device has entered the location associated with the inpatient. Spencer teaches that further cause the one or more processors to:
detect that a third user device has entered a location associated with inpatient, wherein the third user device is associated with the patient (See inpatient environment such as a hospital mentioned in P0036, see micro-location device with mobile software app in Abstract used to detect the patient’s location (Fig. 17, P0060-P0062); and
trigger the generation, on the first user device, the display for entry of the status order to admit the patient to inpatient in response to the detection that the third user device has entered the location associated with inpatient (See Fig. 7, P0046 a checked-in confirmation message and status indicator such as a “Patient checked-In” message.).
Therefore, it would have been obvious to one of ordinary skill in the art of mobile device patient identifier before the effective filing date of the claimed invention to modify the system of Fitzgerald, Stoudt and Walker to include detecting the location of a patient associated inpatient and trigger a generation that the patient device has entered the location associated with the inpatient as taught by Spencer to help ensure accurate communication between the various parties and equipment mentioned in Spencer’s P0074.
Response to Arguments
Applicant argues that the independent claims are directed to a specific, computer-implemented technique for automatically synchronizing inconsistent encounter information across multiple clinical systems and user devices, and updating a clinician's graphical user interface with synchronized data so that claim information is complete, see pgs. 13 and 16 of Remarks — Examiner disagrees.
No technology is being used synchronizing inconsistent encounter information across multiple clinical systems and user devices, and updating a clinician's graphical user interface. For example, technologies such artificial intelligence (AI) or recognition software are not claimed in a meaningful way, but rather the instant case relies on a clinician to use a computer to gather information, the clinician to notice inconsistencies and the computer to display resulting updates. The computer is specifically used for implementing the abstract idea. Again, the claim submission that the Applicant is talking about doesn’t have any technology implemented.
Applicant argues that the computer operations are not reasonably performed "in the human mind or with pen and paper," nor are such activities any of the few, expressly enumerated methods of organizing human activity that are excluded from patentability-in particular these computer operations are not fundamental economic principles or practices, commercial or legal interactions, or management of personal behavior or relationships between people, see pgs. 14-15 of Remarks — Examiner disagrees.
The instant case relies on the clinician or an administrator to use a computer to gather information, pay attention to missing registration information, be a part of a workflow process by receiving status order of a revenue cycle, determine whether that the status order is complete, fixing any patient encounter data as a displayed update. These are activities that the clinician or an administrator would be expected to do mentally and manually, practiced in a healthcare organization, hospital or insurance company.
Applicant argues that the limitations show a distinct arrangement of components that is not well- understood, routine, or conventional, see pgs. 14-15 of Remarks — Examiner disagrees.
The specific features and components of the claimed invention are not explained and are not solving a technological problem with a technological solution, but rather solves an already solved healthcare administrative problem in a non-technical manner. Furthermore, the imitations inform the arrangement of the elements: (1) the revenue cycle management system receives encounter information through network communications; (2) the revenue cycle management system receives a status order from the clinical computer system; (3) the graphical user interface on the clinician's device displays encounter information, accepts the status order, prompts that the order cannot be completed, and accepts entry of the status order as a planned status order; (4) the revenue cycle management system monitors the clinical computer system through the network communications for information updates from a second user device; (5) the revenue cycle management system receives the missing information and synchronizes it; and (6) the clinician's device is updated with the synchronized information are also well-understood, routine and conventional in the art, evidenced by at least paragraphs 16, 19, 34, 39, 53 including Table 1 on pages 6-8, of Craycraft et al. (US 2009/0157436 A1) and paragraphs 18, 26, 29, 76 and figures 2, Fig. 4 of Wojtusiak et al. (US 2013/0054259 A1).
Applicant’s arguments have been fully considered, but are now moot in view of the new grounds of rejection. The Examiner has entered a new rejection under 35 USC § 103(a) and applied new art and art already of record.
Conclusion
THIS ACTION IS MADE FINAL. Applicant is reminded of the extension of time policy as set forth in 37 CFR 1.136(a).
A shortened statutory period for reply to this final action is set to expire THREE MONTHS from the mailing date of this action. In the event a first reply is filed within TWO MONTHS of the mailing date of this final action and the advisory action is not mailed until after the end of the THREE-MONTH shortened statutory period, then the shortened statutory period will expire on the date the advisory action is mailed, and any nonprovisional extension fee (37 CFR 1.17(a)) pursuant to 37 CFR 1.136(a) will be calculated from the mailing date of the advisory action. In no event, however, will the statutory period for reply expire later than SIX MONTHS from the mailing date of this final action.
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/T.S.W./Examiner, Art Unit 3687 03/07/2026
/ALAAELDIN M. ELSHAER/Primary Examiner, Art Unit 3687