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 Applicant’s communication filed on 08/27/2025.
Claims 1-5, 7, 9-15, 17, 19 and 20 have been amended and are hereby entered.
Claims 1-20 are currently pending and have been examined.
This action is made FINAL.
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 first medical procedure data…; standardizing the first medical procedure data, wherein the standardizing comprises: parsing the non-standardized first medical procedure data to determine at least a first procedure data detail; converting the first procedure data detail into a first data identifier of a first standard data structure; and populating the first data identifier within a first data table, the first data table being a first standardized template form; receiving non-standardized second medical procedure data,…; standardizing the second medical procedure data, wherein the standardizing comprises: parsing the non-standardized second medical procedure data to determine at least a second procedure data detail; converting the second procedure data detail into a second data identifier of a second standard data structure, wherein each of the first standard data structure and the second standard data structure comprises one or more of an alphanumeric phrase and/or marker; and populating the second data identifier within the first data table; determining, based on the first data identifier within the first data table, a first procedure; …obtain reimbursement cost data associated with the first procedure; determining, based on the second data identifier within the first data table, a first procedure status associated with the first procedure; determining, based on the first procedure status, a cost range based on the reimbursement cost data; and communicating the cost range for display...
The limitations above, as drafted, is a process that, under the broadest reasonable interpretation, covers certain methods of organizing human activity (i.e., managing personal behavior including following rules or instructions) but for recitation of generic computer components. That is, other than reciting a system implemented by a processor (computer) (claim 11), the claimed invention amounts to managing personal behavior or interaction between people. For example, but for the GUI, user device and databases (claims 1 and 11), and the processor and memory (claim 11), this claim encompasses a person collecting data, standardizing it, determining a cost range and communicating the range in the manner described in the identified abstract idea, supra. If a claim limitation, under its broadest reasonable interpretation, covers managing personal behavior or interactions between people 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. 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 first user device, a cost database and receiving video data. 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 first user device, a cost database, a plurality of databases, video data, 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 first user device, a cost database, a plurality of databases, video data, 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), further in view of Baum et al. (US 20210398624).
Regarding Claim 1, Chen discloses the following limitations:
A method comprising: receiving non-standardized first medical procedure data from a graphical user interface (GUI) of a first 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 first user device). The received data may include clinical notes of a healthcare provider in unstructured formats (receiving non-standardized first medical procedure data). – abstract; paras 7, 39, 42-43, 51)
standardizing the first medical procedure data, wherein the standardizing comprises: parsing the non-standardized first medical procedure data to determine at least a first procedure data detail; (Chen discloses parsing the textual content within the clinical notes (parsing the non-standardized first medical procedure data) with natural language processing to provide section segmentation of the clinical notes (determine at least a first procedure data detail) 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)
converting the first procedure data detail into a first data identifier of a first standard data structure; (Chen discloses that the clinical notes are parsed and segmented into sections (the first procedure data detail) and then assigned a CUI (converting the first procedure data detail into a first data identifier) (see figure 3B). The CUI is an identifier that uniquely represents a chronic condition, and generally, the CUI does not vary (a first standard data structure). – paras 58; FIG 3B)
and populating the first data identifier within a first data table, the first data table being a first standardized template form; (Chen discloses outputting a table of CUIs (populating the first data identifier within a first data table) assigned to the segmented sections of the clinical notes in figure 3B where the CUIs make up the first column and the chronic name makes up the second column, and there are rows 0-2 (a first standardized template form). – paras 13, 58; FIG. 3B)
receiving non-standardized second medical procedure data,…(Chen discloses obtaining one or more clinical notes, indicating that more than one set of unstructured data may be obtained. – paras 7, 39)
standardizing the second medical procedure data, wherein the standardizing comprises: parsing the non-standardized second medical procedure data to determine at least a second procedure data detail; (Chen discloses parsing the textual content within the clinical notes (parsing the non-standardized second medical procedure data) with natural language processing to provide section segmentation of the clinical notes (data to determine at least a second procedure data detail) 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 52-54; FIG. 3A-1; FIG. 4)
converting the second procedure data detail into a second data identifier of a second standard data structure, (Chen discloses that the clinical notes are parsed and segmented into sections (the second procedure data detail) and then assigned a CUI (converting the second procedure data detail into a second data identifier) (see figure 3B). The CUI is an identifier that uniquely represents a chronic condition, and generally, the CUI does not vary (of a second standard data structure). – paras 58; FIG 3B)
wherein each of the first standard data structure and the second standard data structure comprises one or more of an alphanumeric phrase and/or marker; (Chen discloses that Unified Medical Language System (UMLS) concept unique identifiers (CUIs) are used (each standard data structure comprises one or more of an alphanumeric phrase). – para 58) (Examiner notes that the UMLS CUIs are known to be alphanumeric code. CUI contain the letter C followed by seven numbers. This is further evidenced by the NIH (National Institutes of Health. (2022). Unique identifiers in the metathesaurus. U.S. National Library of Medicine. https://web.archive.org/web/20220802102838/https://www.nlm.nih.gov/research/umls/new_users/online_learning/Meta_005.html))
and populating the second data identifier within the first data table; (Chen discloses outputting a table of all the different CUIs (populating the second data identifier within the first data table) assigned to the segmented sections of the clinical notes in figure 3B where the CUIs make up the first column and the chronic name makes up the second column, and there are rows 0-2 (a first standardized template form). – paras 13, 58; FIG. 3B)
determining, based on the first data identifier within the first data table, a first procedure; (Chen discloses that the at least one candidate that is generated (determining a first procedure) provides at least one current procedural terminology (CPT) medical code based on the parsed textual content (and thus the assigned CUI) (based on the first data identifier within the first data table). – abstract; paras 58-59; FIG. 3B)
accessing a cost database to obtain reimbursement cost associated with the first procedure; (Chen discloses that candidates may be used to determine medical codes using predefined rules stored within the database (accessing a cost database). Generally, the pre-defined rules include detailed official guidelines used within the medical billing industry such as the International Classification of Diseases (ICD) and the Current Procedural Terminology (CPT). CPT codes are five-digit alphanumeric codes used to identify services provided to patients such as medical, surgical, diagnostic, and radiological services (associated with the first procedure). These codes are submitted with ICD-10 codes on claim forms to payers and used to determine reimbursement to a provider/facility (obtain reimbursement cost). – para 66)
determining, based on the second data identifier within the first data table, a first procedure status associated with the first procedure; (Chen discloses parsing the textual content with NLP using a pre-defined dictionary, applying a set of pre-defined rules to the parsed textual content to generate at least one candidate, which in Figure 3B has a corresponding CUI (based on the second data identifier within the first data table), to provide at least one current procedural terminology (CPT) medical code (determining a first procedure status) based on the parsed textual content (associated with the first procedure). – paras 58, 66, 71-72) (Examiner notes that it is known in the art that CPT codes are submitted by Physicians to insurance companies after offering a procedure or service to patients. This is further evidence by AIMS Education (Categories of CPT codes & how they are used: AIMS education. Categories of CPT Codes & How They Are Used | AIMS Education. (2022, May 13). https://aimseducation.edu/blog/what-are-cpt-codes) Therefore, the “procedure status” disclosed by Chen is that the procedure has been completed.)
determining, based on the first procedure status, a cost…based on the reimbursement cost data; (Chen discloses that the one or more medical codes (based on the reimbursement cost data) 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 (based on the first procedure status) have a direct impact on how much a patient pays for medical services (determining a cost). – paras 5, 39, 66)
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:
determining…a cost range…; (Hopkins teaches that historical data associated with prior prescription transactions is utilized to determine an estimated cost range (determining 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).
Chen and Hopkins do not disclose the following limitations met by Baum:
…the second medical procedure data comprising video data;(Baum teaches methods and systems for automated intake of patient data. Unstructured audio and visual data such as video data (comprising video data) is received and converted into structured data. – abstract; paras 18-19, 21-22, 25; FIG. 1)
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 processing unstructured data as disclosed by Chen to incorporate processing unstructured video data as taught by Baum in order to avoid inaccuracies that are seen in manually provided data (see Baum para 3).
Regarding Claim 2, Chen, Hopkins and Baum disclose all the limitations above and further disclose the following limitations:
The method of claim 1, further comprising: generating first requirements data based on first medical procedure details; (Chen discloses that candidates may be used (based on first medical procedure details) to determine medical codes using predefined rules stored within the database (generating first requirements data). – para 66)
obtaining, based on the first requirements data, first medical billing form section data associated with a plurality of form sections; (Chen discloses that the pre-defined rules (the first 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 first 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 each of the plurality of form section of the first medical billing form section data to create a medical billing form, wherein the medical procedure details are determined, at least in part, from the first 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 each of the plurality of form section of the first 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, Hopkins and Baum disclose all the limitations above and further disclose the following limitations:
The method of claim 2, wherein the non-standardized first 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 first 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, Hopkins and Baum disclose all the limitations above and further disclose the following limitations:
The method of claim 3, wherein the first 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 first 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, Hopkins and Baum disclose all the limitations above and further disclose the following limitations:
The method of claim 4, wherein the first 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 first 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) (first 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, Hopkins and Baum 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, Hopkins and Baum 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 first medical procedure data from a graphical user interface (GUI) of a first 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 first user device). The received data may include clinical notes of a healthcare provider in unstructured formats (receiving non-standardized first medical procedure data). – abstract; paras 7, 39, 42-43, 51)
standardizing the first medical procedure data, wherein the standardizing comprises: parsing the non-standardized first medical procedure data to determine at least a first procedure data detail; (Chen discloses parsing the textual content within the clinical notes (parsing the non-standardized first medical procedure data) with natural language processing to provide section segmentation of the clinical notes (determine at least a first procedure data detail) 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)
converting the first procedure data detail into a first data identifier of a first standard data structure; (Chen discloses that the clinical notes are parsed and segmented into sections (the first procedure data detail) and then assigned a CUI (converting the first procedure data detail into a first data identifier) (see figure 3B). The CUI is an identifier that uniquely represents a chronic condition, and generally, the CUI does not vary (a first standard data structure). – paras 58; FIG 3B)
and populating the first data identifier within a first data table, the first data table being a first standardized template form; (Chen discloses outputting a table of CUIs (populating the first data identifier within a first data table) assigned to the segmented sections of the clinical notes in figure 3B where the CUIs make up the first column and the chronic name makes up the second column, and there are rows 0-2 (a first standardized template form). – paras 13, 58; FIG. 3B)
receiving non-standardized second medical procedure data… (Chen discloses obtaining one or more clinical notes, indicating that more than one set of unstructured data may be obtained. – paras 7, 39)
standardizing the second medical procedure data, wherein the standardizing comprises: parsing the non-standardized second medical procedure data to determine at least a second procedure data detail; (Chen discloses parsing the textual content within the clinical notes (parsing the non-standardized second medical procedure data) with natural language processing to provide section segmentation of the clinical notes (data to determine at least a second procedure data detail) 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 52-54; FIG. 3A-1; FIG. 4)
converting the second procedure data detail into a second data identifier of a second standard data structure, wherein each of the first standard data structure and the second standard data structure comprises one or more of an alphanumeric phrase and/or marker; (Chen discloses that Unified Medical Language System (UMLS) concept unique identifiers (CUIs) are used (each standard data structure comprises one or more of an alphanumeric phrase). – para 58) (Examiner notes that the UMLS CUIs are known to be alphanumeric code. CUI contain the letter C followed by seven numbers. This is further evidenced by the NIH (National Institutes of Health. (2022). Unique identifiers in the metathesaurus. U.S. National Library of Medicine. https://web.archive.org/web/20220802102838/https://www.nlm.nih.gov/research/umls/new_users/online_learning/Meta_005.html))
and populating the second data identifier within the first data table; (Chen discloses outputting a table of all the different CUIs (populating the second data identifier within the first data table) assigned to the segmented sections of the clinical notes in figure 3B where the CUIs make up the first column and the chronic name makes up the second column, and there are rows 0-2. – paras 13, 58; FIG. 3B)
determining, based on the first data identifier within the first data table ,a first procedure; (Chen discloses that the at least one candidate that is generated (determining a first procedure) provides at least one current procedural terminology (CPT) medical code based on the parsed textual content (and thus the assigned CUI) (based on the first data identifier within the first data table). – abstract; paras 58-59; FIG. 3B)
accessing a cost database of the plurality of databases to obtain reimbursement cost data associated with the first procedure; (Chen discloses that candidates may be used to determine medical codes using predefined rules stored within the database (accessing a cost database). Generally, the pre-defined rules include detailed official guidelines used within the medical billing industry such as the International Classification of Diseases (ICD) and the Current Procedural Terminology (CPT). CPT codes are five-digit alphanumeric codes used to identify services provided to patients such as medical, surgical, diagnostic, and radiological services (associated with the first procedure). These codes are submitted with ICD-10 codes on claim forms to payers and used to determine reimbursement to a provider/facility (obtain reimbursement cost). – para 66)
determining, based on the second data identifier within the first data table, a first procedure status associated with the first procedure; (Chen discloses parsing the textual content with NLP using a pre-defined dictionary, applying a set of pre-defined rules to the parsed textual content to generate at least one candidate, which in Figure 3B has a corresponding CUI (based on the second data identifier within the first data table), to provide at least one current procedural terminology (CPT) medical code (determining a first procedure status) based on the parsed textual content (associated with the first procedure). – paras 58, 66, 71-72) (Examiner notes that it is known in the art that CPT codes are submitted by Physicians to insurance companies after offering a procedure or service to patients. This is further evidence by AIMS Education (Categories of CPT codes & how they are used: AIMS education. Categories of CPT Codes & How They Are Used | AIMS Education. (2022, May 13). https://aimseducation.edu/blog/what-are-cpt-codes) Therefore, the “procedure status” disclosed by Chen is that the procedure has been completed.)
determining, based on the first procedure status, a cost…based on reimbursement the cost data; (Chen discloses that the one or more medical codes (based on the reimbursement cost data) 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 (based on the first procedure status) have a direct impact on how much a patient pays for medical services (determining a cost). – paras 5, 39, 66)
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:
determining…a cost range…; (Hopkins teaches that historical data associated with prior prescription transactions is utilized to determine an estimated cost range (determining 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).
Chen and Hopkins do not disclose the following limitations met by Baum:
…the second medical procedure data comprising video data;(Baum teaches methods and systems for automated intake of patient data. Unstructured audio and visual data such as video data (comprising video data) is received and converted into structured data. – abstract; paras 18-19, 21-22, 25; FIG. 1)
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 processing unstructured data as disclosed by Chen to incorporate processing unstructured video data as taught by Baum in order to avoid inaccuracies that are seen in manually provided data (see Baum para 3).
Regarding Claim 12, Chen, Hopkins and Baum disclose all the limitations above and further disclose the following limitations:
The system of claim 11, wherein the operations further comprise: generating first requirements data based on first medical procedure details; (Chen discloses that candidates may be used (based on first medical procedure details) to determine medical codes using predefined rules stored within the database (generating first requirements data). – para 66)
obtaining, based on the first requirements data, first medical billing form section data associated with a plurality of form sections; (Chen discloses that the pre-defined rules (the first 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 first 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 each of the plurality of form sections of the first medical billing form section data to create a medical billing form, wherein the medical procedure details are determined, at least in part, from the first 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 each of the plurality of form sections of the first 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, Hopkins and Baum disclose all the limitations above and further disclose the following limitations:
The system of claim 12, wherein the non-standardized first 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 first 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, Hopkins and Baum disclose all the limitations above and further disclose the following limitations:
The system of claim 13, wherein the first 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 first 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 15, Chen, Hopkins and Baum disclose all the limitations above and further disclose the following limitations:
The system of claim 14, wherein the first 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 16, Chen, Hopkins and Baum 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, Hopkins and Baum 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), in view of Baum et al. (US 20210398624), further in view of Lo et al. (US 20200387635).
Regarding Claim 7, Chen, Hopkins and Baum disclose all the limitations above, however do not disclose the following limitations met by Lo:
The method of claim 1, wherein the standardizing the first 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, Hopkins, Baum and Lo disclose all the limitations above and further disclose the following limitations:
The system of claim 11, wherein the standardizing the first 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), in view of Baum et al. (US 20210398624 ), further in view of Zahora et al. (US 20220309592).
Regarding Claim 9, Chen, Hopkins and Baum 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 reimbursement 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, Baum and Zahora disclose all the limitations above and further disclose the following limitations:
The method of claim 1, wherein the first medical 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 first 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, Baum 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 reimbursement 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, Baum and Zahora disclose all the limitations above and further disclose the following limitations:
The system of claim 11, wherein the first medical 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 first 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).
Response to Arguments
Regarding rejections under 35 USC § 112(b) to Claims 1-20, Applicant’s arguments have been fully considered and are persuasive. Examiner has withdrawn the rejection.
Regarding rejections under 35 USC § 101 to Claims 1-20, Applicant’s arguments have been fully considered, and are not persuasive. The rejection has been updated in light of latest amendments. Applicant argues:
(a) Under step 2A Prong 2 of the Mayo framework, the amended independent claims recite a technique where non-standard data, including video data, is converted into a standardized structure that includes an alphanumeric phrase and/or marker that can then be populated into a data table and how such standardized structures are then utilized for processing. The amended claims are, thus, necessarily rooted in computer technology as the amended claims recite a technique of standardizing various non-standard data by converting the non-standard data into a standard data shape. Such techniques are necessarily rooted in computer technology as the elements of the amended claims would only apply to the operation of computers as a human being does not operate in different data formats and, furthermore, such data formats include explicitly recited video data. Furthermore, such techniques are improvements to existing computer technology as standardizing a plurality of different forms of non-standard data, which may then be centrally stored as templates within a single data structure and accessed according, as recited in the amended claims, allow for (1) memory savings that would otherwise be wasted due to the storage of vast numbers of non-standardized data forms AND (2) processing savings as systems do not need to waste processing to determine the appropriate form to select from within the database. (p. 11-12; emphasis original).
Regarding (a), Examiner respectfully disagrees. MPEP 2106.04(d)(1) states "the word 'improvements' in the context of this consideration is limited to improvements to the functioning of a computer or any other technology/technical field, whether in Step 2A Prong Two or in Step 2B." The technological environment of Applicant’s claim is a general-purpose computer (see Applicant’s Spec. paras 38-44, 103-105). Applicant has not identified nor can the Examiner locate any physical improvement to the functioning of the computer that results from the implementation of Applicant’s claim. There is no indication that the computer is made to reduce memory requirements or processing power. In fact, the computer may be caused to operate less efficiently through the implementation of Applicant’s claimed invention; we do not know. For example, the processing and standardization of data may be more processing intensive than simply loading a stored pre-created form. Because neither type of improvement is present in the claims, an improvement to technology is not present and there is no practical application. The claimed invention is using a computer as a tool and any improvement present is an improvement to the abstract idea of, to paraphrase, determine medical reimbursement cost information. The Examiner notes that certain “method[s] of organizing human activity” includes a person’s interaction with a computer (see MPEP 2106.04(a)(2)(II))].
(b) Furthermore, under step 2B of the Mayo framework, the amended independent claims recite an inventive concept that is "significantly more" than the recited judicial exception. Specifically, the amended independent claims recite a system where "instead of utilizing stored pre-created forms, aggregates non-standardized data from a plurality of sources to create standardized form modules. For each instance, the appropriate form modules that would obtain the needed data for the situation is determined, accessed, and combined into the appropriate form for a specific submission. As such, the specific standardized entries that are needed are identified and aggregated." (Specification, paragraph [0015].) Such an inventive concept is significantly more than a mental process and certain methods of organizing human activity as the system recites a particular arrangement of elements, such as database elements that include parsing and converting data details into data identifiers of a first data structure and populating the identifiers into a standardized template form and utilizing the data identifiers to identify procedures and procedure details for communication, that are necessarily rooted in computer technology. Such elements allow for the improvement of the operation of computers through reduction in memory and processing storage requirements, as described herein. (p. 12).
Regarding (b), Examiner respectfully disagrees. MPEP 2106.05(II) states that Step 2B asks: Does the claim recite additional elements that amount to significantly more than the judicial exception? Examiners should answer this question by first identifying whether there are any additional elements (features/limitations/steps) recited in the claim beyond the judicial exception(s), and then evaluating those additional elements individually and in combination to determine whether they contribute an inventive concept (i.e., amount to significantly more than the judicial exception(s)). (emphasis original).
The instant claim does not include additional elements that are sufficient to amount to significantly more than the judicial exception. As discussed in the updated rejection above with respect to integration of the abstract idea into a practical application, the additional element of using a graphical user interface (GUI) of a first user device, a cost database, a plurality of databases, video data, a memory, a processor and instructions to perform the noted steps amounts to no more than mere instructions to apply the exception using a generic computer component. Mere instructions to apply an exception using a generic computer component cannot provide an inventive concept (“significantly more”).
Regarding rejections under 35 USC § 103 to Claims 1-20, Applicant’s arguments have been fully considered and are not persuasive. The rejection has been updated in light of latest amendments. Applicant argues:
(c) None of the cited references disclose standardizing non-standard data at all. In fact, Chen, Hopkins, and Lo do not include any reference to standardization. Zahora only briefly discloses standardized forms, but does not disclose or even mention any standardization techniques for use with databases and certainly does not disclose the techniques for standardizing non-standard procedure data as recited in the amended independent claims. Hence, the cited references, considered alone or in combination, fail to disclose or suggest several features recited in claims 1 and 11 as amended. (p. 13).
Regarding (c), Examiner respectfully disagrees. The claim recites “standardizing the first medical procedure data, wherein the standardizing comprises: parsing the non-standardized first medical procedure data to determine at least a first procedure data detail”. Chen discloses providing medical codes (i.e., a structured data format) directly from unstructured clinical notes. Unstructured data by definition lacks a predefined, common format or data model, and therefore reads on the recited “non-standardized” data. Examiner further notes that the claim recites that the standardizing comprises parsing the non-standardized data and Examiner relies upon Chen to disclose parsing of unstructured data. See updated rejection above
Hopkins, Lo and Zahora are not relied upon to teach any data standardization steps. Hopkins is relied upon to teach a cost range; Lo is relied upon to teach data anonymization; and Zahora is relied upon to teach a likelihood of payout and identifying information that may be unknown/unavailable but is relevant to the medical claim. Thus, Examiner respectfully submits that the cited references above teach all limitations recited in amended claim 1. Based on response to arguments above, claim 1 is unpatentable and therefore similar independent claim 11, as well as all claims depending therefrom, are unpatentable according to the same rationale.
Conclusion
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.
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/K.E.V./Examiner, Art Unit 3681
/PETER H CHOI/Supervisory Patent Examiner, Art Unit 3681
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