DETAILED ACTION
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 .
Status of Claims
This action is in reply to the present application filed on March 3, 2023.
In the preliminary amendment dated March 24, 2023, the following has occurred: Claims 1-3 and 5-20 have been amended.
Claims 1-20 are currently pending and have been examined.
Information Disclosure Statement
The information disclosure statement (IDS) submitted on March 3, 2023 was filed before the mailing date of the first office action on the merits. The submission is in compliance with the provisions of 37 CFR 1.97. Accordingly, the information disclosure statement is being considered by the examiner.
Claim Rejections - 35 USC § 112(b)
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 are 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.
Claim 1 recites the limitation "the procedure data" in line 11. The claim recites non-standardized medical procedure data, standardized medical procedure data, and in the immediate proceeding step, procedure details; thus, when referring to “the procedure data” it is unclear what is being referred to. For purposes of examination and compact prosecution, Examiner is interpreting “the procedure data” to be the procedure details as recited previously in claim 1 (see also Applicant’s specification para 77 and FIG. 5). However, clarification and correction are required.
Claim 1 further recites the limitation "the cost data" in line 12. There is insufficient antecedent basis for this limitation in the claim. For purposes of examination and compact prosecution, Examiner is interpreting “the cost data” to be the cost data elements as recited previously in claim 1. However, clarification and correction are required.
Claim 11 recites substantially similar limitations to those in claim 1 and is rejected on the same basis as stated above. Claims 2-10 and 12-20 are further rejected as being dependent on a rejected base claim.
Claim 2 recites the limitation "the medical procedure details" in line 2. There is insufficient antecedent basis for this limitation in the claim. For purposes of examination and compact prosecution, Examiner is interpreting “the medical procedure details” to be the procedure details as recited previously in claim 1. However, clarification and correction are required.
Claim 12 recites substantially similar limitations to those in claim 2 and is rejected on the same basis as stated above. Claims 3-5 and 13-14 are further rejected as being dependent on a rejected base claim.
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 an abstract idea without significantly more.
Step 1 analysis:
Claims 1 and 11 are directed to a method and a system respectively and therefore all fall into one of the four statutory categories. (Step 1: Yes, the claims fall into one of the four statutory categories).
Step 2A analysis - Prong one:
The substantially similar independent method, and system claims, taking claim 1 as exemplary, recite the following limitations: receiving non-standardized medical procedure data…; standardizing the medical procedure data, wherein the standardizing comprises: parsing the non-standardized medical procedure data to determine procedure data details; and creating standardized medical procedure data, the standardized medical procedure data comprising a standard data structure, wherein the parsed procedure data details are populated within the standard data structure; determining, based on the standardized medical procedure data, procedure details; determining cost data elements based on the procedure data; …obtain the cost data indicating the cost data elements; forecasting a cost range based on the cost data elements; and communicating the cost range for display...
The series of steps as recited above describe observations, evaluations, opinions, and managing personal behavior or relationships or interactions between people including following rules or instructions and are thus are grouped as a mental process and certain methods of organizing human activity which are abstract ideas. See MPEP 2106.04(a)(2). (Step 2A – Prong 1: Yes, the claims are abstract).
Step 2A analysis - Prong two:
Claims 1 and 11 recite additional elements beyond the abstract idea. Claims 1 and 11 recite a graphical user interface (GUI) of a user device and a cost database. Claim 11 further recites a plurality of databases, a memory, a processor and instructions. The claims are applying generic computer components to the recited abstract limitations. The recited instructions appear to be software.
This judicial exception is not integrated into a practical application. In particular, the claims recite a graphical user interface (GUI) of a user device, a cost database, a plurality of databases, a memory, a processor and instructions which are recited at a high-level of generality (i.e., as a generic processor performing generic computer functions) such that it amounts to no more than mere instructions to apply the exceptions using a generic computer component. For example, Applicant’s specification explains that the processor receives input data, reads instructions, analyzes data, executes control functions, etc. (see Applicant’s specification para 42). Accordingly, this/these additional element(s), when considered separately and as an ordered combination, do not integrate the abstract idea into a practical application because it/they does/do not impose any meaningful limits on practicing the abstract idea. Therefore, Claims 1 and 11 are directed to an abstract idea without practical application. (Step 2A – Prong 2: No, the additional claimed elements are not integrated into a practical application).
Step 2B analysis:
For the next step of the analysis, it must be determined whether the limitations present in the claims represent a patent-eligible application of the abstract idea. A claim directed to a judicial exception must be analyzed to determine whether the elements of the claim, considered both individually and as an ordered combination are sufficient to ensure that the claim as a whole amounts to significantly more than the exception itself.
For the role of a computer in a computer implemented invention to be deemed meaningful in the context of this analysis, it must involve more than performance of well-understood, routine, and conventional activities previously known to the industry. Further, the mere recitation of a generic computer cannot transform a patent ineligible abstract idea into a patent-eligible invention. See MPEP 2106.05(d).
Applicant’s specification discloses the following:
Applicant describes embodiments of the disclosure at a very high level to include the use of a wide variety of user devices, processors, networks, databases, machine learning techniques, memories, buses, interfaces, etc. (see Applicant’s spec paras 38-44, 103-105). The invention, may use any computer via any transmission medium (a communication network or broadcast waves) capable of transmitting the program.
Generic computer components recited as performing generic computer functions that are well-understood, routine and conventional activities amount to no more than implementing the abstract idea with a computerized system.
Looking at the limitations as an ordered combination adds nothing that is not already present when looking at the elements taken individually. There is no indication that the combination of elements improves the functioning of a computer or improves any other technology. The collective functions appear to be implemented using conventional computer systemization.
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 integration of the abstract idea into a practical application, the additional elements of a graphical user interface (GUI) of a user device, a cost database, a plurality of databases, a memory, a processor and instructions to perform all of the steps discussed above amount to no more than mere instructions to apply the exceptions using generic computer components. Mere instructions to apply an exception using a generic computer component cannot provide an inventive concept. The claims do not provide an inventive concept significantly more than the abstract idea. Accordingly, these additional elements, when considered separately and as an ordered combination, do not integrate the abstract idea into a practical application because they do not impose any meaningful limits on practicing the abstract idea. (Step 2B: No, the claims do not provide significantly more).
Dependent Claims 2-10 and 12-20 further define the abstract idea that is presented in independent Claims 1 and 11 respectively, and are further grouped as a mental process and certain methods of organizing human activity and are abstract for the same reasons and basis as presented above. No further hardware components other than those found in the independent claims are recited, thus it is presumed that the claims are further utilizing the same generic systemization as presented in the independent claims. The claims do not recite additional elements that integrate the judicial exception into a practical application when considered both individually and as an ordered combination. Therefore, the dependent claims are also directed to an abstract idea.
Thus, Claims 1-20 are rejected under 35 U.S.C. 101 as being directed to abstract ideas without significantly more.
Claim Rejections - 35 USC § 103
This application currently names joint inventors. In considering patentability of the claims the examiner presumes that the subject matter of the various claims was commonly owned as of the effective filing date of the claimed invention(s) absent any evidence to the contrary. Applicant is advised of the obligation under 37 CFR 1.56 to point out the inventor and effective filing dates of each claim that was not commonly owned as of the effective filing date of the later invention in order for the examiner to consider the applicability of 35 U.S.C. 102(b)(2)(C) for any potential 35 U.S.C. 102(a)(2) prior art against the later invention.
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.
Claims 1-6, 8, 11-16 and 18 are rejected under 35 U.S.C. 103 as being unpatentable over Chen et al. (US 20240047055) in view of Hopkins et al. (US 11636548).
Regarding Claim 1, Chen discloses the following limitations:
A method comprising: receiving non-standardized medical procedure data from a graphical user interface (GUI) of a user device; (Chen discloses receiving data via the network to and/or from one or more external computer systems (e.g., a laptop computer, a computer monitor, a screen, a touchscreen, a smart phone, etc.) (from a graphical user interface (GUI) of a user device). The received data may include clinical notes of a healthcare provider in unstructured formats (receiving non-standardized medical procedure data). – abstract; paras 7, 39, 42-43, 51)
standardizing the medical procedure data, wherein the standardizing comprises: parsing the non-standardized medical procedure data to determine procedure data details; (Chen discloses parsing the textual content within the clinical notes (parsing the non-standardized medical procedure data) with natural language processing to provide section segmentation of the clinical notes (determine procedure data details) as a pre-classification step. For example, in FIG. 3, a first section 40a includes the section header 42a “CHIEF COMPLAINT” with section data 44a stating, “[d]ecreased ability to perform daily living activity secondary to recent right hip surgery.” – abstract; paras 53-54; FIG. 3A-1; FIG. 4)
and creating standardized medical procedure data, the standardized medical procedure data comprising a standard data structure, wherein the parsed procedure data details are populated within the standard data structure; (Chen discloses that a set of predefined rules are applied to the parsed textual content to generate at least one candidate (creating standardized medical procedure data). The at least one candidate may provide at least one current procedural terminology (CPT) medical code (comprising a standard data structure) based on the parsed textual content (the parsed procedure data details are populated within the standard data structure). – abstract; para 52)
determining, based on the standardized medical procedure data, procedure details; (Chen discloses that the candidates (based on the standardized medical procedure data) may be chronic disease candidates or common disorder candidate (determining procedure details). – paras 58-59; FIG. 3B)
determining cost data elements based on the procedure data; (Chen discloses that the candidate (based on the procedure data) may be evaluated to determine one or more CPT codes (determining cost data elements) wherein CPT codes have a direct impact on how much a patient pays for medical services. – paras 5, 71-72)
accessing a cost database to obtain the cost data indicating the cost data elements; (Chen discloses that candidates may be used to determine medical codes (e.g., CPT codes) (obtain the cost data indicating the cost data elements) using predefined rules stored within the database (accessing a cost database). – para 66)
forecasting a cost…based on the cost data elements; (Chen discloses that the one or more medical codes (based on the cost data elements) may be provided to one or more medical billing systems configured to coordinate between healthcare provider, patients, and/or insurance providers to obtain payment for services rendered by the healthcare provider to the patient. Wherein the CPT codes (the cost data elements) have a direct impact on how much a patient pays for medical services (forecasting a cost). – paras 5, 39)
and communicating the cost…for display on the GUI of the user device. (Chen discloses the one or more processors may allow users (e.g., healthcare providers, physicians, medical personnel, medical billing system) of the external systems (e.g., a laptop computer, a computer monitor, a screen, a touchscreen, a smart phone, etc.) (for display on the GUI of the user device) access via the network to provide and/or receive data, such as the medical code(s) (communicating the cost). – paras 39, 42-43, 48)
Chen does not disclose the following limitations met by Hopkins:
forecasting a cost range…; (Hopkins teaches that historical data associated with prior prescription transactions is utilized to determine an estimated cost range (forecasting a cost range) of a prescribed medication in the event of an insufficient or absent response from a benefits manager. – abstract)
and communicating the cost range... (Hopkins teaches providing the estimated cost range (communicating the cost range) to a prescriber via a computer to share with a patient. – abstract; col 2, lines 9-10 )
It would have been obvious to a person of ordinary skill in the art before the effective filing date of the claimed invention to have modified providing medical codes associated with payment for medical services as disclosed by Chen to incorporate providing an estimated cost range as taught by Hopkins in order to provide a patient with accurate medication cost information (see Hopkins col 13, line 66-col 14, line 4).
Regarding Claim 2, Chen and Hopkins disclose all the limitations above and further disclose the following limitations:
The method of claim 1, further comprising: generating requirements data based on the medical procedure details; (Chen discloses that candidates may be used (based on the medical procedure details) to determine medical codes using predefined rules stored within the database (generating requirements data). – para 66)
obtaining, based on the requirements data, medical billing form section data associated with a plurality of form sections; (Chen discloses that the pre-defined rules (the requirements data) include detailed official guidelines used within the medical billing industry such as the International Classification of Diseases (ICD) and the Current Procedural Terminology (CPT) (obtaining medical billing form section data associated with a plurality of form sections). The pre-defined rules within the database may identify each level of service (e.g., comprehensive, high risk). – para 66)
and combining the medical billing form section data to create a medical billing form, wherein the medical procedure details are determined, at least in part, from the medical billing form section data. (Chen discloses that the CPT codes are five-digit alphanumeric codes used to identify services provided to patients such as medical, surgical, diagnostic, and radiological services. These codes are submitted with ICD-10 codes (combining the medical billing form section data) on claim forms (create a medical billing form) to payers and used to determine reimbursement to a provider/facility. – para 66)
Regarding Claim 3, Chen and Hopkins disclose all the limitations above and further disclose the following limitations:
The method of claim 2, wherein the non-standardized medical procedure data comprises a request for the medical billing form, the medical billing form configured to obtain data in accordance with the requirements of a vendor. (Chen discloses that the CPT codes determined from the clinical notes (the non-standardized medical procedure data) are submitted with ICD-10 codes on claim forms to payers and used to determine reimbursement to a provider/facility (a request for the medical billing form). For example, according to Centers for Medicare and Medicaid Services (CMS) guidelines, a doctor visit with “Comprehensive” history component, “Comprehensive” examination component, and “High Risk” medical decision making component may be coded as CPT 99205 (obtain data in accordance with the requirements of a vendor). – para 4, 66)
Regarding Claim 4, Chen and Hopkins disclose all the limitations above and further disclose the following limitations:
The method of claim 3, wherein the requirements data comprises identification of the data to be obtained in accordance with the requirements of the vendor. (Chen discloses that the predefined rules stored within the database (the requirements data) may identify each level of service (e.g., comprehensive, high risk) and contain guidelines for the CPT codes (identification of the data to be obtained in accordance with the requirements of the vendor). – para 66)
Regarding Claim 5, Chen and Hopkins disclose all the limitations above and further disclose the following limitations:
The method of claim 4, wherein the medical billing form section data, when combined into the medical billing form, is configured to allow for input of the data to be obtained in accordance with the requirements of the vendor. (Chen discloses the pre-defined rules (the requirements data) include detailed official guidelines used within the medical billing industry such as the International Classification of Diseases (ICD) and the Current Procedural Terminology (CPT) (medical billing form section data). The pre-defined rules within the database may identify each level of service (e.g., comprehensive, high risk). The medical claim (the medical billing form), having the one or more codes, is submitted (allow for input of the data) to a payer or clearinghouse that can process the medical claim usually by evaluation by a medical claim examiner and/or a medical claim adjuster. – paras 4-5, 66)
Regarding Claim 6, Chen and Hopkins disclose all the limitations above and further disclose the following limitations:
The method of claim 1, wherein the cost database is configured to store medical cost data categorized based on one or more of a vendor, request, reimbursement amount, and/or reimbursement timeframe, (Chen discloses that the database (the cost database) stores CPT coding guidelines (store medical cost data) within the predefined rules which directly impact payment for services rendered by the healthcare provider (categorized based on reimbursement amount). – paras 5, 39, 66)
and wherein the medical cost data comprises one or more of vendor responses to requests, an average or range of reimbursement provided by vendors, and/or an average or range of time required to provide reimbursement in response to requests. (Chen discloses storing CPT coding guidelines (an average of reimbursement provided by vendors) in the database. – paras 5, 39,66) (The monetary value associated with a CPT code represents the national average that Medicare pays a provider for the service rendered. This position is further evidenced by the following reference DeVry University (Medical Coding Classification Systems: DeVry University. devry.edu. (2022, April 22). https://www.devry.edu/blog/understanding-medical-codes-and-coding-classification-systems.html) under the section titled “Types of CPT Codes”)
Regarding Claim 8, Chen and Hopkins disclose all the limitations above and further disclose the following limitations:
The method of claim 1, further comprising: determining a medical procedure status associated with the medical procedure data. (Chen discloses that the parsed textual content from the clinical notes (associated with the medical procedure data) may include information associated with surgery discharge summaries, chief complaints, medical history, a physical examination, mental status, etc. (determining a medical procedure status). – paras 51-52; FIGs. 3A-1, 3A-2, 3A-3, 3B)
Regarding Claim 11, Chen discloses the following limitations:
A system comprising: a plurality of databases; a memory; and a processor, configured to receive instructions from the memory and perform operations comprising: (Chen discloses the use of processors, memories, and instructions to perform the claimed functions. – paras 33-34, 41-42)
receiving non-standardized medical procedure data from a graphical user interface (GUI) of a user device; (Chen discloses receiving data via the network to and/or from one or more external computer systems (e.g., a laptop computer, a computer monitor, a screen, a touchscreen, a smart phone, etc.) (from a graphical user interface (GUI) of a user device). The received data may include clinical notes of a healthcare provider in unstructured formats (receiving non-standardized medical procedure data). – abstract; paras 7, 39, 42-43, 51)
standardizing the medical procedure data, wherein the standardizing comprises: parsing the non-standardized medical procedure data to determine procedure data details; (Chen discloses parsing the textual content within the clinical notes (parsing the non-standardized medical procedure data) with natural language processing to provide section segmentation of the clinical notes (determine procedure data details) as a pre-classification step. For example, in FIG. 3, a first section 40a includes the section header 42a “CHIEF COMPLAINT” with section data 44a stating, “[d]ecreased ability to perform daily living activity secondary to recent right hip surgery.” – abstract; paras 53-54; FIG. 3A-1; FIG. 4)
and creating standardized medical procedure data, the standardized medical procedure data comprising a standard data structure, wherein the parsed procedure data details are populated within the standard data structure; (Chen discloses that a set of predefined rules are applied to the parsed textual content to generate at least one candidate (creating standardized medical procedure data). The at least one candidate may provide at least one current procedural terminology (CPT) medical code (comprising a standard data structure) based on the parsed textual content (the parsed procedure data details are populated within the standard data structure). – abstract; para 52)
determining, based on the standardized medical procedure data, procedure details; (Chen discloses that the candidates (based on the standardized medical procedure data) may be chronic disease candidates or common disorder candidate (determining procedure details). – paras 58-59; FIG. 3B)
determining cost data elements based on the procedure data; (Chen discloses that the candidate (based on the procedure data) may be evaluated to determine one or more CPT codes (determining cost data elements) wherein CPT codes have a direct impact on how much a patient pays for medical services. – paras 5, 71-72)
accessing a cost database of the plurality of databases to obtain the cost data indicating the cost data elements; (Chen discloses that candidates may be used to determine medical codes (e.g., CPT codes) (obtain the cost data indicating the cost data elements) using predefined rules stored within the database (accessing a cost database). – para 66)
forecasting a cost…based on the cost data elements; (Chen discloses that the one or more medical codes (based on the cost data elements) may be provided to one or more medical billing systems configured to coordinate between healthcare provider, patients, and/or insurance providers to obtain payment for services rendered by the healthcare provider to the patient. Wherein the CPT codes (the cost data elements) have a direct impact on how much a patient pays for medical services (forecasting a cost). – paras 5, 39)
and communicating the cost…for display on the GUI of the user device. (Chen discloses the one or more processors may allow users (e.g., healthcare providers, physicians, medical personnel, medical billing system) of the external systems (e.g., a laptop computer, a computer monitor, a screen, a touchscreen, a smart phone, etc.) (for display on the GUI of the user device) access via the network to provide and/or receive data, such as the medical code(s) (communicating the cost). – paras 39, 42-43, 48)
Chen does not disclose the following limitations met by Hopkins:
forecasting a cost range…; (Hopkins teaches that historical data associated with prior prescription transactions is utilized to determine an estimated cost range (forecasting a cost range) of a prescribed medication in the event of an insufficient or absent response from a benefits manager. – abstract)
and communicating the cost range... (Hopkins teaches providing the estimated cost range (communicating the cost range) to a prescriber via a computer to share with a patient. – abstract; col 2, lines 9-10 )
It would have been obvious to a person of ordinary skill in the art before the effective filing date of the claimed invention to have modified providing medical codes associated with payment for medical services as disclosed by Chen to incorporate providing an estimated cost range as taught by Hopkins in order to provide a patient with accurate medication cost information (see Hopkins col 13, line 66-col 14, line 4).
Regarding Claim 12, Chen and Hopkins disclose all the limitations above and further disclose the following limitations:
The system of claim 11, wherein the operations further comprise: generating requirements data based on the medical procedure details; (Chen discloses that candidates may be used (based on the medical procedure details) to determine medical codes using predefined rules stored within the database (generating requirements data). – para 66)
obtaining, based on the requirements data, medical billing form section data associated with a plurality of form sections; (Chen discloses that the pre-defined rules (the requirements data) include detailed official guidelines used within the medical billing industry such as the International Classification of Diseases (ICD) and the Current Procedural Terminology (CPT) (obtaining medical billing form section data associated with a plurality of form sections). The pre-defined rules within the database may identify each level of service (e.g., comprehensive, high risk). – para 66)
and combining the medical billing form section data to create a medical billing form, wherein the medical procedure details are determined, at least in part, from the medical billing form section data. (Chen discloses that the CPT codes are five-digit alphanumeric codes used to identify services provided to patients such as medical, surgical, diagnostic, and radiological services. These codes are submitted with ICD-10 codes (combining the medical billing form section data) on claim forms (create a medical billing form) to payers and used to determine reimbursement to a provider/facility. – para 66)
Regarding Claim 13, Chen and Hopkins disclose all the limitations above and further disclose the following limitations:
The system of claim 12, wherein the non-standardized medical procedure data comprises a request for the medical billing form, the medical billing form configured to obtain data in accordance with the requirements of a vendor. (Chen discloses that the CPT codes determined from the clinical notes (the non-standardized medical procedure data) are submitted with ICD-10 codes on claim forms to payers and used to determine reimbursement to a provider/facility (a request for the medical billing form). For example, according to Centers for Medicare and Medicaid Services (CMS) guidelines, a doctor visit with “Comprehensive” history component, “Comprehensive” examination component, and “High Risk” medical decision making component may be coded as CPT 99205 (obtain data in accordance with the requirements of a vendor). – para 4, 66)
Regarding Claim 14, Chen and Hopkins disclose all the limitations above and further disclose the following limitations:
The system of claim 13, wherein the requirements data comprises identification of the data to be obtained in accordance with the requirements of the vendor, (Chen discloses that the predefined rules stored within the database (the requirements data) may identify each level of service (e.g., comprehensive, high risk) and contain guidelines for the CPT codes (identification of the data to be obtained in accordance with the requirements of the vendor). – para 66)
and wherein the medical billing form section data, when combined into the medical billing form, is configured to allow for input of the data to be obtained in accordance with the requirements of the vendor. (Chen discloses the pre-defined rules (the requirements data) include detailed official guidelines used within the medical billing industry such as the International Classification of Diseases (ICD) and the Current Procedural Terminology (CPT) (medical billing form section data). The pre-defined rules within the database may identify each level of service (e.g., comprehensive, high risk). The medical claim (the medical billing form), having the one or more codes, is submitted (allow for input of the data) to a payer or clearinghouse that can process the medical claim usually by evaluation by a medical claim examiner and/or a medical claim adjuster. – paras 4-5, 66)
Regarding Claim 15, Chen and Hopkins disclose all the limitations above and further disclose the following limitations:
The system of claim 11, wherein the non-standardized procedure data comprises audio, video, and/or images. (Chen discloses transcription of the clinical note (the non-standardized procedure data) may be via speech (comprises audio) to recognition software. – paras 47, 51)
Regarding Claim 16, Chen and Hopkins disclose all the limitations above and further disclose the following limitations:
The system of claim 11, wherein the cost database is configured to store medical cost data categorized based on one or more of a vendor, request, reimbursement amount, and/or reimbursement timeframe, (Chen discloses that the database (the cost database) stores CPT coding guidelines (store medical cost data) within the predefined rules which directly impact payment for services rendered by the healthcare provider (categorized based on reimbursement amount). – paras 5, 39, 66)
and wherein the medical cost data comprises one or more of vendor responses to requests, an average or range of reimbursement provided by vendors, and/or an average or range of time required to provide reimbursement in response to requests. (Chen discloses storing CPT coding guidelines (an average of reimbursement provided by vendors) in the database. – paras 5, 39,66) (The monetary value associated with a CPT code represents the national average that Medicare pays a provider for the service rendered. This position is further evidenced by the following reference DeVry University (Medical Coding Classification Systems: DeVry University. devry.edu. (2022, April 22). https://www.devry.edu/blog/understanding-medical-codes-and-coding-classification-systems.html) under the section titled “Types of CPT Codes”)
Regarding Claim 18, Chen and Hopkins disclose all the limitations above and further disclose the following limitations:
The system of claim 11, wherein the operations further comprise: determining a medical procedure status associated with the medical procedure data. (Chen discloses that the parsed textual content from the clinical notes (associated with the medical procedure data) may include information associated with surgery discharge summaries, chief complaints, medical history, a physical examination, mental status, etc. (determining a medical procedure status). – paras 51-52; FIGs. 3A-1, 3A-2, 3A-3, 3B)
Claims 7 and 17 are rejected under 35 U.S.C. 103 as being unpatentable over Chen et al. (US 20240047055) in view of Hopkins et al. (US 11636548) as applied to claims 1-6, 8, 11-16 and 18 above, and further in view of Lo et al. (US 20200387635).
Regarding Claim 7, Chen and Hopkins disclose all the limitations above, however do not disclose the following limitations met by Lo:
The method of claim 1, wherein the standardizing the medical procedure data further comprises: anonymizing the medical procedure data. (Lo teaches anonymizing medical patient data (anonymizing the medical procedure data) prior to converting medical reports to common formats (standardizing). – abstract; paras 1-3, 82-83; FIG. 8)
It would have been obvious to a person of ordinary skill in the art before the effective filing date of the claimed invention to have further modified parsing the textual content within the un-structured clinical notes as disclosed by Chen to incorporate data anonymization as taught by Lo in order to provide a practical, easy-enough solution for the hospital sites and their staff to employ (see Lo para 6).
Regarding Claim 17, Chen and Hopkins disclose all the limitations above, however do not disclose the following limitations met by Lo:
The system of claim 11, wherein the standardizing the medical procedure data further comprises: anonymizing the medical procedure data. (Lo teaches anonymizing medical patient data (anonymizing the medical procedure data) prior to converting medical reports to common formats (standardizing). – abstract; paras 1-3, 82-83; FIG. 8)
It would have been obvious to a person of ordinary skill in the art before the effective filing date of the claimed invention to have further modified parsing the textual content within the un-structured clinical notes as disclosed by Chen to incorporate data anonymization as taught by Lo in order to provide a practical, easy-enough solution for the hospital sites and their staff to employ (see Lo para 6).
Claims 9-10 and 19-20 are rejected under 35 U.S.C. 103 as being unpatentable over Chen et al. (US 20240047055) in view of Hopkins et al. (US 11636548) as applied to claims 1-6, 8, 11-16 and 18 above, and further in view of Zahora et al. (US 20220309592).
Regarding Claim 9, Chen and Hopkins disclose all the limitations above, however do not disclose the following limitations met by Zahora:
The method of claim 8, further comprising: determining, based on the cost data and the medical procedure status, a lead status, wherein the lead status indicates a likelihood of payout and/or a payout lead time. (Zahora teaches accurate predictions of the likelihood of a payer to remit medical claims payments (a likelihood of payout) and may include information regarding reimbursement amounts. – paras 93)
It would have been obvious to a person of ordinary skill in the art before the effective filing date of the claimed invention to have further modified the system and method of generating medical codes from clinical notes indicating service provider reimbursement as disclosed by Chen to incorporate predicting a likelihood of reimbursement as taught by Zahora in order to enable providers to make informed decisions on the staffing and medical equipment purchases to better serve the needs of their patients. (see Zahora para 91).
Regarding Claim 10, Chen, Hopkins and Zahora disclose all the limitations above and further disclose the following limitations:
The method of claim 1, wherein the procedure data comprises a request, and the method further comprises: determining that transaction entity data is unavailable, wherein the transaction entity data comprises historical data generated by an entity associated with the medical procedure data; (Zahora teaches a process of finding and identifying information relevant to a medical claim that may be unknown and/or unavailable (determining that transaction entity data is unavailable) to a patient, payer, and/or provider. The predictive analytics platform, for example, may analyze the patient data records (historic claims data 120) (transaction entity data comprises historical data) to identify claims reimbursement records corresponding to the same billing code(s) and the same payer. – paras 92, 113)
determining key data bits associated with portions of the request; obtaining non-entity data based on the key data bits; (Zahora teaches that where direct comparison is unavailable or includes very limited data points, records corresponding to similar billing codes and/or similar plans (determining key data bits) may be identified (obtaining non-entity data) and analyzed by the predictive analytics platform. – paras 92, 113)
and determining a forecast based on the non-entity data. (Zahora teaches the predictive analytics platform identifies patient data records corresponding to a same payer plan as the first patient's plan to forecast reimbursement (determining a forecast) based upon identical plan information. – paras 92, 94, 113)
It would have been obvious to a person of ordinary skill in the art before the effective filing date of the claimed invention to have further modified the system and method of generating medical codes from clinical notes indicating service provider reimbursement as disclosed by Chen to incorporate identifying similar data when certain data is unknown/unavailable and using the similar data to forecast reimbursement as taught by Zahora in order to enable providers to make informed decisions on the staffing and medical equipment purchases to better serve the needs of their patients. (see Zahora para 91).
Regarding Claim 19, Chen, Hopkins and Zahora disclose all the limitations above and further disclose the following limitations:
The system of claim 18, wherein the operations further comprise: determining, based on the cost data and the medical procedure status, a lead status, wherein the lead status indicates a likelihood of payout and/or a payout lead time. (Zahora teaches accurate predictions of the likelihood of a payer to remit medical claims payments (a likelihood of payout) and may include information regarding reimbursement amounts. – paras 93)
It would have been obvious to a person of ordinary skill in the art before the effective filing date of the claimed invention to have further modified the system and method of generating medical codes from clinical notes indicating service provider reimbursement as disclosed by Chen to incorporate predicting a likelihood of reimbursement as taught by Zahora in order to enable providers to make informed decisions on the staffing and medical equipment purchases to better serve the needs of their patients. (see Zahora para 91).
Regarding Claim 20, Chen, Hopkins and Zahora disclose all the limitations above and further disclose the following limitations:
The system of claim 11, wherein the procedure data comprises a request, and the operations further comprise: determining that transaction entity data is unavailable, wherein the transaction entity data comprises historical data generated by an entity associated with the medical procedure data; (Zahora teaches a process of finding and identifying information relevant to a medical claim that may be unknown and/or unavailable (determining that transaction entity data is unavailable) to a patient, payer, and/or provider. The predictive analytics platform, for example, may analyze the patient data records (historic claims data 120) (transaction entity data comprises historical data) to identify claims reimbursement records corresponding to the same billing code(s) and the same payer. – paras 92, 113)
determining key data bits associated with portions of the request; obtaining non-entity data based on the key data bits; (Zahora teaches that where direct comparison is unavailable or includes very limited data points, records corresponding to similar billing codes and/or similar plans (determining key data bits) may be identified (obtaining non-entity data) and analyzed by the predictive analytics platform. – paras 92, 113)
and determining a forecast based on the non-entity data. (Zahora teaches the predictive analytics platform identifies patient data records corresponding to a same payer plan as the first patient's plan to forecast reimbursement (determining a forecast) based upon identical plan information. – paras 92, 94, 113)
It would have been obvious to a person of ordinary skill in the art before the effective filing date of the claimed invention to have further modified the system and method of generating medical codes from clinical notes indicating service provider reimbursement as disclosed by Chen to incorporate identifying similar data when certain data is unknown/unavailable and using the similar data to forecast reimbursement as taught by Zahora in order to enable providers to make informed decisions on the staffing and medical equipment purchases to better serve the needs of their patients. (see Zahora para 91).
Relevant Prior Art of Record Not Currently Being Applied
The prior art made of record and not relied upon is considered pertinent to applicant's
disclosure.
Agatstein (US 20230118853) discloses standardizing unstructured data including images of medical notes to produce textual medical notes using natural language processing.
Conclusion
Any inquiry concerning this communication or earlier communications from the examiner should be directed to KIMBERLY VANDER WOUDE whose telephone number is (703)756-4684. The examiner can normally be reached M-F 9 AM-5 PM.
Examiner interviews are available via telephone, in-person, and video conferencing using a USPTO supplied web-based collaboration tool. To schedule an interview, applicant is encouraged to use the USPTO Automated Interview Request (AIR) at http://www.uspto.gov/interviewpractice.
If attempts to reach the examiner by telephone are unsuccessful, the examiner’s supervisor, PETER H CHOI can be reached on (469) 295-9171. The fax phone number for the organization where this application or proceeding is assigned is 571-273-8300.
Information regarding the status of published or unpublished applications may be obtained from Patent Center. Unpublished application information in Patent Center is available to registered users. To file and manage patent submissions in Patent Center, visit: https://patentcenter.uspto.gov. Visit https://www.uspto.gov/patents/apply/patent-center for more information about Patent Center and https://www.uspto.gov/patents/docx for information about filing in DOCX format. For additional questions, contact the Electronic Business Center (EBC) at 866-217-9197 (toll-free). If you would like assistance from a USPTO Customer Service Representative, call 800-786-9199 (IN USA OR CANADA) or 571-272-1000.
/K.E.V./Examiner, Art Unit 3681
/PETER H CHOI/Supervisory Patent Examiner, Art Unit 3681