DETAILED ACTION
Notices to Applicant
This communication is a Non-Final Office Action on the merits. Claims 1-20 as filed 02/03/2026, 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 .
Continued Examination Under 37 CFR 1.114
A request for continued examination under 37 CFR 1.114, including the fee set forth in 37 CFR 1.17(e), was filed in this application after final rejection. Since this application is eligible for continued examination under 37 CFR 1.114, and the fee set forth in 37 CFR 1.17(e) has been timely paid, the finality of the previous Office action has been withdrawn pursuant to 37 CFR 1.114. Applicant's submission filed on 02/03/2026 has been entered.
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 Objections
Claim 1, 10, and 17 are objected to because of the following informalities: each independent claim recites “responsive to receive the provider response” the claims should read “responsive to receiving the provider response” (See e.g. claim 1, line 24).
Appropriate correction is required.
Claim Rejections - 35 USC § 112
The following is a quotation of 35 U.S.C. 112(b):
(b) CONCLUSION.—The specification shall conclude with one or more claims particularly pointing out and distinctly claiming the subject matter which the inventor or a joint inventor regards as the invention.
The following is a quotation of 35 U.S.C. 112 (pre-AIA ), second paragraph:
The specification shall conclude with one or more claims particularly pointing out and distinctly claiming the subject matter which the applicant regards as his invention.
Claims 1-20 is rejected under 35 U.S.C. 112(b) or 35 U.S.C. 112 (pre-AIA ), second paragraph, as being indefinite for failing to particularly point out and distinctly claim the subject matter which the inventor or a joint inventor (or for applications subject to pre-AIA 35 U.S.C. 112, the applicant), regards as the invention.
Independent claim 1 recites “a user interface” in line 3, then “the user interface” in line 7, and then again recites “a user interface” in line 51. It is unclear as to whether these three recitations of a user interface are the same or different claim element. As a result, the claim is indefinite. Independent claims 10 and 17 each recite the same unclear and indefinite elements of a user interface, such that claims 1-20 are rejected for failing to particularly point out and distinctly claim the subject matter of the invention.
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 1-20 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 1-9 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 are drawn to a machine-readable storage device for generating a requested impact summary, which is within the four statutory categories (i.e. manufacture).
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, procedures, 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;
responsive to receive the provider response or detecting expiration of the query, programmatically invoking one or more 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, where 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” a temporary summary impact table to produce impact review summary information;
when the requested impact summary is a realized incremental impact summary, retrieving, from the computer readable storage device 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 realized delta between the actual codeset and the baseline codeset;
when the requested impact summary is an anticipated incremental impact summary, retrieving, from the computer readable storage device 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, an anticipated delta between the actual codeset and the baseline codeset;
when the requested impact summary is a missed opportunity incremental impact summary retrieving, from the computer readable storage device 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 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 a user interface rendered on a display device communicatively coupled to the one or more computer processors, an impact summary view that simultaneously displays 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 view, the anticipated delta between the anticipated codeset and the baseline codeset in the anticipated impact analysis view, and the missed-opportunity delta in the incremental missed opportunity view.
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, procedures, 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; storing (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; responsive to receive 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 more risk-of-mortality scores, receiving a request for an impact summary, where 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 the impact summary, generating, “on the fly” a temporary summary impact table to produce impact review summary information; when the requested impact summary is a realized incremental impact summary, retrieving the initial codeset associated with the query as specified by the unique identifier and computing a realized delta between the actual codeset and the baseline codeset; when the requested impact summary is an anticipated incremental impact summary, retrieving, the initial codeset associated with the query as specified by the unique identifier and computing an anticipated delta between the actual codeset and the baseline codeset; when the requested impact summary is a 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 expiration of the query without a provider response relate 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,” 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 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 “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,” 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). 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 2-9, 11-16, and 18-20 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,” however, the implementation of the displayed query template 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). Therefore the dependent claims are rejected under 35 U.S.C. § 101.
Response to Arguments
Applicant's arguments filed 02/03/2026 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 02/03/2026.
In the remarks, Applicant argues in substance that:
Regarding the 112 rejections of claims 1-20, Applicant argues that amendments to the claims address all issues and the rejections should be withdrawn; and
Regarding the 101 rejection of claims 1-20, Applicant argues that claims 1-20 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.
In response to Applicant’s argument that (a) regarding the 112 rejections of claims 1-20, Examiner is persuaded and has withdrawn the prior 112 rejections. Examiner notes new 112(b) rejections in view of the amendment.
In response to Applicant’s argument that (b) regarding the 101 rejection of claims 1-20, Examiner respectfully disagrees.
First, under Step 2A, Prong One, Applicant argues the claims are not directed to a Mental Process because the claims recite elements that are rooted in an improvement to technology through a computer-implemented data architecture for a revenue cycle system technology beyond a mental process. 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, 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 Mental Process 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 through 1) generating unique identifiers establishing a link between a specific CDI query and the initial codeset; 2) invoking DRG groupers; 3) generates a transient table responsive to a user-requested impact summary that is “on the fly,” and 4) the claims require simultaneous presentation of three distinct analysis view. 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. Second, Examiner respectfully submits that invoking a DRG Grouper, in view of the present Application Specification ([0077]) is a software component for analyzing code sets, which is a general purpose component invoking software a high level of generality to perform the abstract idea (i.e. computing classifications/scores) such that it does not reflect an improvement to a technical problem in the field/functioning of a computer, but rather used in its ordinary capacity. See MPEP 2106.05(f)(2). Third, generating a temporary table “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 a temporary table is performing 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. Lastly, 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 unconventional aspects as “not a generic billing workflow.” 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). These claim limitations, when viewed in combination, reflect an alleged improvement to the abstract idea itself.
Accordingly, the 101 rejection of claims 1-20 is maintained as applied in the above Office Action.
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. 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]).
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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If attempts to reach the examiner by telephone are unsuccessful, the examiner’s supervisor, Fonya Long can be reached at (571) 270-5096. The fax phone number for the organization where this application or proceeding is assigned is 571-273-8300.
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/A.M.B./Examiner, Art Unit 3682
/FONYA M LONG/Supervisory Patent Examiner, Art Unit 3682