rsABDETAILED ACTION
Notices to Applicant
This communication is a Final Office Action on the merits. Claims 1, 5-17, and 19-24 as filed 06/10/2026, are currently pending and have been considered below.
The present application, filed on or after March 16, 2013, is being examined under the first inventor to file provisions of the AIA .
Priority
This application is a national stage filing under 35 U.S.C. 371 of PCT/IB2020/060976, filed November 20, 2020, which claims the benefit of U.S. Application No. 62/938,534, filed November 21, 2019, the disclosure of which is incorporated by reference in its/their entirety herein.
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, 5-17 and 19-24 are rejected under 35 U.S.C. 101 because the claimed invention is directed to a judicial exception (i.e., an abstract idea) without significantly more.
Claims 1, 5-9 and 21-23 are drawn to a computer implemented method for generating a requested impact summary, which is within the four statutory categories (i.e. method).
Claims 10-16 and 24 are drawn to a machine-readable storage device for generating a requested impact summary, which is within the four statutory categories (i.e. machine).
Claims 17-20 are drawn to a device for generating a requested impact summary, which is within the four statutory categories (i.e. machine).
Independent Claim 1 (and substantially similar independent claims 10 and 17) is rejected under 35 U.S.C. 101 because the claimed invention is directed to an abstract idea without significantly more. Claim 1 recites (bold added for identification of additional elements):
1. A computer-implemented method performed by a revenue cycle application executing on one or more computer processors and comprising a clinical documentation integrity (CDI) module and a coding module that generates a user interface and communicates over a network with provider interfaces, the method comprising:
generating, by the revenue cycle application, a first interface view showing a first diagnosis for a patient during a patient encounter with a healthcare provider;
receiving, via the user interface and at one or more computer processors, a query soliciting further specificity with respect to a patient encounter with a healthcare provider;
making the query available to a provider device as an electronic communication through the provider interface;
generating, when the query is made available and by the one or more computer processors, a unique identifier for an initial codeset specified by the query, wherein the initial codeset includes all diagnosis codes, procedure codes, and grouper results associated with a patient encounter and each of one of the diagnosis codes, procedure codes, and grouper results, when grouped with other ones of the diagnosis codes, procedure codes, and grouper results associated with encounter, causes further information concerning the encounter to be generated;
establishing, by the one or more computer processors, a link between the initial codeset and the query, wherein the link is established, at least in part by associating the unique identifier with the query;
storing, in a data store of the revenue cycle application and associated with the unique identifier, (i) a baseline codeset for the encounter, (ii) an anticipated result code computed for the query prior to a provider response, and (iii) an actual result upon receipt of a documented response, wherein each subsequent revision of the codeset that occurs in response to an addition, edit, or deletion of a code is stored in the data store as a new revision having a new unique identifier and associated save event data, the save event data including an event date and time, a unique event identifier, and an indication of a user role associated with the save event, the user role indicating whether CDI or coding staff performed the save event
responsive to receiving the provider response or detecting expiration of the query, programmatically invoking, by the one or more computer processors, one or more diagnosis-related group (DRG) groupers to compute, for each of the baseline anticipated, and actual code sets, at least one of one or more respective DRG classification, one or more respective severity-of-illness scores, and one or e more risk-of-mortality scores;
receiving, by the one or more computer processors, a request for an impact summary, wherein the requested impact summary is one of a realized incremental impact summary, an anticipated incremental impact summary, and a missed opportunity incremental impact summary;
responsive to receiving the request for an impact summary, generating, “on the fly” by a stored procedure executing on the one or more computer processors, a temporary summary impact table to produce impact review summary information, the temporary summary impact table including a plurality of fields populated for the requested impact summary, the plurality of fields including a baseline severity field, a baseline risk field, a baseline weight field, a final severity field, a final risk field, a final weight field, a query-impact parameter field, and a reimbursement-impact field;
when the requested impact summary is the realized incremental impact summary, retrieving, from the data store and by the one or more computer processors, the initial codeset associated with the query as specified by the unique identifier, applying, by the stored procedure, the set of codeset-modification rules based on the anticipated result code and the baseline code specified by the query to generate an anticipated modified codeset, providing the anticipated modified codeset in the structured-data format to the external coding and reimbursement system over the network, receiving, from the external coding and reimbursement system, anticipated structured-data evaluation results and computing, by the one or more computer processors, a realized delta between the actual codeset and the baseline codeset based on the structured-data evaluation results;
when the requested impact summary is the anticipated incremental impact summary, retrieving, from the data store and by the one or more computer processors, the initial codeset associated with the query as specified by the unique identifier applying, by the stored procedure, the set of codeset-modification rules based on the anticipated result code and the baseline code specified by the query to generate an anticipated modified codeset, providing the anticipated modified codeset in the structured-data format to the external coding and reimbursement system over the network, receiving, from the external coding and reimbursement system, anticipated structured-data evaluation results, and computing, by the one or more computer processors, an anticipated delta between the actual codeset and the baseline codeset;
when the requested impact summary is the missed opportunity incremental impact summary retrieving, from the data store and by the one or more computer processors, the initial codeset associated with the query as specified by the unique identifier and computing, by the one or more computer processors, a missed-opportunity delta based on the expiration of the query without a provider response related to the baseline codeset;
generating, by the one or more computer processors, the requested impact summary by populating the temporary summary impact table with relevant information responsive to the requested impact summary; and
presenting, within a review tab in the user interface rendered on a display device communicatively coupled to the one or more computer processors, an impact summary view that simultaneously displays: a realized incremental impact analysis view, an anticipated impact analysis view, and an incremental missed opportunity impact analysis view, wherein each view includes visual indicators that illustrate the realized delta between the actual codeset and the baseline codeset for the realized incremental impact analysis view, the anticipated delta between the anticipated modified codeset and the baseline codeset in the anticipated impact analysis view, and the missed-opportunity delta in the incremental missed opportunity impact analysis view and wherein the visual indicators include directional arrows indicating whether respective values of severity, risk, and reimbursement impact moved up or down between the baseline codeset and a corresponding one of the actual codeset, the anticipated modified codeset, and the baseline codeset.
The above claim, as drafted, is a method that, under its broadest reasonable interpretation, managing personal behavior or interactions between people through following rules or instructions, but for the recitation of generic computer components. That is, other than reciting the above bolded limitations, the claim amounts to rules or instructions for organizing human activity. For example, but for the above bolded language, receiving a query soliciting further specificity with respect to a patient encounter with a healthcare provider; generating a unique identifier for an initial codeset specified by the query, wherein the initial codeset includes all diagnosis codes, procedure codes, and grouper results associated with a patient encounter and each of one of the diagnosis codes, procedure codes, and grouper results, when grouped with other ones of the diagnosis codes, procedure codes, and grouper results associated with encounter, causes further information concerning the encounter to be generated; establishing a link between the initial codeset and the query, wherein the link is established, at least in part by associating the unique identifier with the query; (i) a baseline codeset for the encounter, (ii) an anticipated result code computed for the query prior to a provider response, and (iii) an actual result upon receipt of a documented response, wherein each subsequent revision of the codeset that occurs in response to an addition, edit, or deletion of a code as a new revision having a new unique identifier and associated save event data, the save event data including an event date and time, a unique event identifier, and an indication of a user role associated with the save event, the user role indicating whether CDI or coding staff performed the save event; responsive to receiving the provider response or detecting expiration of the query for each of the baseline anticipated, and actual code sets, at least one of one or more respective DRG classification, one or more respective severity-of-illness scores, and one or e more risk-of-mortality scores; receiving a request for an impact summary, wherein the requested impact summary is one of a realized incremental impact summary, an anticipated incremental impact summary, and a missed opportunity incremental impact summary; responsive to receiving the request for an impact summary, generating, “on the fly” by a stored procedure, a temporary summary impact table to produce impact review summary information, the temporary summary impact table including a plurality of fields populated for the requested impact summary, the plurality of fields including a baseline severity field, a baseline risk field, a baseline weight field, a final severity field, a final risk field, a final weight field, a query-impact parameter field, and a reimbursement-impact field; when the requested impact summary is the realized incremental impact summary, retrieving the initial codeset associated with the query as specified by the unique identifier, applying, by the stored procedure, the set of codeset-modification rules based on the anticipated result code and the baseline code specified by the query to generate an anticipated modified codeset, providing the anticipated modified codeset in the structured-data format, receiving anticipated structured-data evaluation results and computing, a realized delta between the actual codeset and the baseline codeset based on the structured-data evaluation results; when the requested impact summary is the anticipated incremental impact summary, retrieving the initial codeset associated with the query as specified by the unique identifier applying, by the stored procedure, the set of codeset-modification rules based on the anticipated result code and the baseline code specified by the query to generate an anticipated modified codeset, providing the anticipated modified codeset in the structured-data format, receiving, anticipated structured-data evaluation results, and computing an anticipated delta between the actual codeset and the baseline codeset; when the requested impact summary is the missed opportunity incremental impact summary, retrieving, the initial codeset associated with the query as specified by the unique identifier and computing a missed-opportunity delta based on the expiration of the query without a provider response related to the baseline codeset; generating the requested impact summary by populating the temporary summary impact table with relevant information responsive to the requested impact summary in the context of this claim encompasses rules or instructions for managing personal behavior or interactions between people for generating a requested impact summary. If a claim limitation, under its broadest reasonable interpretation, managing personal behavior or interactions between people through rules or instructions but for the recitation of generic computer components, then it falls within the “Certain Methods of Organizing Human Activity” grouping of abstract ideas. Accordingly, the claim recites an abstract idea.
This judicial exception is not integrated into a practical application. In particular, the claims only recite each of the above bolded additional elements, for example, using “a revenue cycle application executing on one or more computer processors and comprising a clinical documentation integrity (CDI) module and a coding module that generates a user interface and communicates over a network with provider interfaces,” “at one or more computer processors,” “a computer readable storage device,” “a data store,” and “a display device,” (and “a machine-readable storage device having instructions for execution by one or more computer processor of a machine that includes a revenue cycle application and a clinical documentation integrity (CDI) module and a coding module that generates a user interface and communicates over a network with provider interfaces to cause the one or more computer processors to perform operations,” “a computer readable storage device,” as per independent claim 10, and “one or more computer processors; a display device communicatively coupled to the one or more processors; a one or more computer processors; a display device communicatively coupled to the one or more processors; and a memory device communicatively coupled to the processor; a revenue cycle application stored in the memory device and executable by the one or more processors, the application comprising: a clinical documentation integrity (CDI) module and coding module configured to generate a user interface and communicate over a network with provider interfaces; instructions that when execution by the one or more processors” as per independent claim 17) to perform the claim limitations. The elements in each of these steps are recited at a high-level of generality (i.e., digital signal process, ASIC, microprocessor or other type of processor operating on a computing system such as a personal computer, a storage device such as a non-transitory memory or other type of hardware-based storage devices, and a display device such as computer with input, output, and communication interfaces such as a touchscreen, as they relate to general purpose computer components (Application Specification [0018], [00168])). The above bolded additional elements related to generating, presenting, and receiving via an interface amounts to using computer interfaces for data input and output under the ordinary capacity of a computer interface as described in the Application Specification. The above bolded additional elements As such, the limitations amount to no more than mere instructions to implement an abstract idea on a computer or other machinery, or merely uses a computer or other machinery in its ordinary capacity as a tool to perform an abstract idea. See MPEP 2106.05(f)(2). Further, the above bolded additional element of “making the query available to a provider device as an electronic communication through the provider interface … when the query is made available” are mere data gathering and output recited at a high level of generality, and thus are insignificant extra-solution activity. See MPEP 2106.05(g). Accordingly, these additional elements do not integrate the abstract idea into a practical application because they do not impose any meaningful limits on practicing the abstract idea. The claim is directed to an abstract idea.
The claim does not include additional elements that are sufficient to amount to significantly more than the judicial exception. As discussed above with respect to integration of the abstract idea into a practical application, each of the above bolded additional elements, such as using, for example, “a revenue cycle application executing on one or more computer processors and comprising a clinical documentation integrity (CDI) module and a coding module that generates a user interface and communicates over a network with provider interfaces,” “at one or more computer processors,” “a computer readable storage device,” “a data store,” and “a display device,” (and “a machine-readable storage device having instructions for execution by one or more computer processor of a machine that includes a revenue cycle application and a clinical documentation integrity (CDI) module and a coding module that generates a user interface and communicates over a network with provider interfaces to cause the one or more computer processors to perform operations,” “a computer readable storage device,” as per independent claim 10, and “a one or more computer processors; a display device communicatively coupled to the one or more processors; a one or more computer processors; a display device communicatively coupled to the one or more processors; and a memory device communicatively coupled to the processor; a revenue cycle application stored in the memory device and executable by the one or more processors, the application comprising: a clinical documentation integrity (CDI) module and coding module configured to generate a user interface and communicate over a network with provider interfaces; instructions that when execution by the one or more processors” as per independent claim 17) to perform the collecting, analyzing, and displaying limitations amounts to no more than mere instructions to apply the exception using a generic computer component. (i.e., digital signal process, ASIC, microprocessor or other type of processor operating on a computing system such as a personal computer, a storage device such as a non-transitory memory or other type of hardware-based storage devices, and a display device such as computer with an output interface such as a touchscreen, as they relate to general purpose computer components (Application Specification [0018], [00168])). The above bolded additional elements related to generating, presenting, and receiving via an interface amounts to using computer interfaces for data input and output under the ordinary capacity of a computer interface as described in the Application Specification. Mere instructions to apply an exception using a computer or other machinery in its ordinary capacity as a tool cannot provide an inventive concept. See MPEP 2106.05(f)(2). Further, the above bolded additional element of “making the query available to a provider device as an electronic communication through the provider interface … when the query is made available” amount to receiving or transmitting data over a network and are well-understood, routine, conventional activity. See MPEP 2106.05(d), subsection II. The claim is not patent eligible.
Dependent claims 5-9, 11-16, and 19-24 include limitations of the independent claim and are directed to the same abstract idea as discussed above and incorporated herein. The dependent claims are rejected under 35 U.S.C. § 101 because they are directed to non-statutory subject matter. These additional claims recite what the patient encounter data is and how it is analyzed. These information characteristics do not integrate the judicial exception into a practical application, and, when viewed individually or as a whole, they do not add anything substantial beyond collecting, analyzing, and displaying patient encounter data. Furthermore, the combination of elements does not indicate a significant improvement to the functioning of a computer or any other technology. Dependent claims 5, 12, and 19 recite the additional elements of “providing, on the display device communicatively coupled to the one or more computer processors, a query template for display, the query template including fields for a principal diagnosis, a response, and a natural language query; and generating the query as a function of the natural language query and one of the first and further diagnoses from a first interface view that is generated by the one or more computer processors,” and dependent claims 21-24 recite additional elements related to storing and displaying via an interface; however, the implementation of the displaying is recited at a high level of generality, such that it amounts to merely using a computer as a tool to perform the abstract idea (i.e. pre-populate user interface components to generate a query (Application Specification at [00134])). See MPEP 2106.05(f)(2). Therefore the dependent claims are rejected under 35 U.S.C. § 101.
Response to Arguments
Applicant's arguments filed 06/10/2026 have been fully considered but they are not persuasive. Applicant’s arguments will be addressed herein below in the order in which they appear in the response filed on 06/10/2026.
In the remarks, Applicant argues in substance that:
Regarding the 101 rejection of claims 1, 5-17 and 19-24, Applicant argues that claims 1-17 and 19-24 are not directed to a Mental Process, recites beyond merely linking the user of the judicial exception to a technological environment, and recites significantly more than the abstract idea; and
Regarding the 112(b) rejection of claims 1, 5-17 and 19-24, Applicant argues the amendments overcome the prior rejection.
In response to Applicant’s argument that (a) regarding the 101 rejection of claims 1, 5-17 and 19-24, Examiner respectfully disagrees.
First, under Step 2A, Prong One, Applicant argues the claims are not directed to an abstract idea because the claims recite elements particular arrangement resulting in an improvement to technology through a computer-implemented data architecture for a revenue cycle system technology beyond an abstract idea. Examiner respectfully disagrees, and submits that under Step 2A, Prong One, the claim limitations amount to rules or instructions for managing personal behavior or interactions between people for generating an impact summary in the context of a revenue cycle. That is, but for the recitation of generic computer components, the claim is directed to the abstract idea of Certain Method of Organizing Human Activity. The additional elements of Applicant’s Remarks (e.g. generating multiple interface views, presenting within a review tab an impact summary view that simultaneously displays multiple impact analysis views with visual indicators, are further consider under Step 2A, Prong 2 and Step 2B. Applicant argues that these limitations also relate to a technical improvement, not an abstract idea. Examiner respectfully submits that this is a consideration under Step 2A, Prong 2 and Step 2B. Under Step 2A, Prong One, as discussed above, the claim recites limitations that are directed to the abstract idea of at least a Certain Methods of Organizing Human Activity but for the recitation of general purpose computer components.
Under Step 2A, Prong Two, Applicant argues that the claims recite an integration into a practical application through an improvement to technology that conventional systems lack any mechanism to preserve the state of the codeset at the precise moment a clinical query is initiated. Examiner respectfully disagrees. First, the limitation of generating a unique identifier for establishing a link between a specific CDI query and an initial codeset is not an additional element, but rather part of the abstract idea merely performed by invoking the one or more computer processors once the query is made available and by the one or more computer processors i.e. input/communicated via an interface. The claim limitations merely continue to save versions with a timestamp, unique event identifier, and role metadata to create the auditable history. Examiner respectfully submits that this is not an improvement to technology, but rather, directed to the abstract idea of Organizing Human Activity through rules or instructions to create an audit log using generic computer components as a tool to perform these functions in their ordinary capacity. Second, Examiner respectfully submits that the claim limitations for displaying the on the user interface the simultaneous display of data including directional arrows representing value amounts to using a display/user interface in its ordinary capacity to output information that is a result of data analysis. This does not represent an improvement into the functioning of the computer or user interface display itself, but rather, invokes using a user interface display in its ordinary capacity to perform the step of the abstract idea. See MPEP 2106.05(f)(2). The impact review tab displaying the impact in a single view merely is presenting the data in a way that previously required a few manual steps in different tabs. This does not improve the functioning of the user interface, but rather, changes what data is displayed in different tabs as a result of the abstract idea. Lastly, generating “on the fly” is part of the abstract idea of a rule or instruction for managing personal behavior or interactions between people, but for the invoking of generic computer components for performing the limitation. “On the fly,” in view the present Application Specification and under broadest reasonable interpretation, is that the generating is performed in real-time and/or dynamically as data is communicated. Accordingly, this does not meaningfully limit the abstract idea beyond using generic computer components for generating a table as a tool. As a result, the additional element of simultaneously displaying three analysis views amounts to using an interface as an output for displaying resulting analysis data under the ordinary capacity of using a computer interface as a tool to display data. See MPEP 2106.05(f)(2). Examiner respectfully submits that, when viewing the additional elements both individually and as a whole, do not recite an integration into a practical application as a particular computer architecture or an improvement to the functioning of a computer or technical field, but rather the claim is directed to merely applying generic computer components as a tool under their ordinary capacity for performing the abstract idea for an alleged problem rooted in the abstract idea itself.
Under Step 2B, Applicant argues that the claims recite significantly more through as particular arrangement of technical elements that result in an improvement to technology. Examiner respectfully submits that Applicant’s arguments are directed to an improvement to the “billing workflow” through using generic computer components as a tool to perform rules or instructions of the workflow. That is, Examiner respectfully submits that the instant claims recite an alleged improvement to the abstract idea itself, and not a technical solution to a technical problem. See MPEP 2106.04, subsection I (Myriad, 569 U.S. at 591, 106 USPQ2d at 1979 ("Groundbreaking, innovative, or even brilliant discovery does not by itself satisfy the §101 inquiry."). Ultramercial, Inc. v. Hulu, LLC, 772 F.3d 709, 714-15, 112 USPQ2d 1750, 1753-54 (Fed. Cir. 2014). Cf. Synopsys, Inc. v. Mentor Graphics Corp., 839 F.3d 1138, 1151, 120 USPQ2d 1473, 1483 (Fed. Cir. 2016) ("a new abstract idea is still an abstract idea") (emphasis in original)) A new abstract idea is still an abstract idea. Examiner respectfully submits that the “meaningful limits” of Applicant’s Remarks are directed to limitations of the abstract idea i.e. a specific technical workflow for producing specific outputs and computations. Examiner respectfully disagrees that the claims recite additional elements that amount to a particular machine, but rather, recite general purpose computer components. (Application Specification [0018], [00168])). The claims are directed to supporting “dynamic comparative analysis,” through the programming of generic computer components to perform the input, output, computation, and communication of data. The user interface additional element does not recite a technical problem that is resolved by the technical solution of an improved user interface, but rather the claim merely recites outputting different data visuals on the user interface in the ordinary capacity of a computer user interface. See MPEP 2106.05(f)(2). These claim limitations, when viewed in combination, reflect an alleged improvement to the abstract idea itself. Further, Examiner respectfully submits, in view of the above Office Action, that the only additional elements that were respectively considered extra-solution activity and thus necessarily analyzed under Berkheimer were making the query available to a provider device as an electronic communication through the provider interface … when the query is made available,” which amount to receiving or transmitting data over a network and are well-understood, routine, conventional activity. See MPEP 2106.05(d), subsection II. The elements discussed in Applicant’s Remarks pg. 30 were considered under the “apply it” standard. See MPEP 2106.05(f)(2).
Examiner respectfully disagrees and submits that the dependent claims and new claims 21-24 (which are directed to the abstract idea and use general purpose computer components in their ordinary capacity to store and display data; See MPEP 2106.05(f)(2)), fail to recite an improvement to technology such that they integrate the claim into a practical application or amount to significantly more than the abstract idea.
Accordingly, the 101 rejection of claims 1, 5-17 and 19-24 is maintained as applied in the above Office Action.
Regarding the 112(b) rejection of claims 1, 5-17 and 19-24, Applicant argues the amendments overcome the prior rejection.
In response to Applicant’s argument that (b) regarding the 112(b) rejection of claims 1, 5-17 and 19-24, Examiner is persuaded and has withdrawn the prior 112(b) rejection.
Conclusion
The prior art made of record and not relied upon is considered pertinent to applicant's disclosure:
U.S. Patent Application Pub. No. 2018/0166172 A1 teaches generating a comparison of the health value continuum to a value baseline for a patient-related event during a visit associated with a patient (Abstract);
U.S. 2014/0337044 A1 teaches Presenting the raw and organized error data for human review and analysis in the form of electronic or printed reports, including dynamic presentations in which the human reviewer can make display and reporting selections including but not limited to the error data under review, the relations between the types of error data, and the style and organization of display. ([0013]);
U.S. Patent Application Pub. No. 2015/0066539 A1 teaches natural language processing system for clinical documentation improvement and generating queries for validation (Abstract);
U.S. Patent Application Pub. No. 2017/0323060 A1 teaches a graphical user interface for modify and finalize billing codes for a patient encounter (Abstract);
U.S. Patent Application Pub. No. 2020/0411171 A1 teaches a review of coding with one or more of Patient Expired, Discharged with pending queries, Query Responded, New DRG Impacting Query Opportunity, New Quality Impacting Query Opportunity, Scheduled for Today, DRG Mismatch, geometric mean length of stay (GMLOS), Missing documents received, New documents received, On Hold-Pending Queries, On Hold-No Queries and Awaiting Reconciliation (0013]).
Applicant's amendment necessitated the new ground(s) of rejection presented in this Office action. Accordingly, THIS ACTION IS MADE FINAL. See MPEP § 706.07(a). 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.
Any inquiry concerning this communication or earlier communications from the examiner should be directed to ANTHONY BALAJ whose telephone number is (571)272-8181. The examiner can normally be reached 8:00 - 4:00 M-F.
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/A.M.B./Examiner, Art Unit 3682
/FONYA M LONG/Supervisory Patent Examiner, Art Unit 3682
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