Method and apparatus for identifying patients overdue for an appointment using standard healthcare billing data

Abstract

A method and apparatus for identifying overdue patients using standard billing or other office management data, so that patients can be contacted and invited to make an appointment. The invention begins by querying the diagnosis codes for each visit from the billing or other encounter tables, and matching these with a set of target medical conditions requiring regular care. Procedure codes and encounter dates for past visits are queried for these patients, to determine when each patient was last seen, and what was done. These procedure codes are matched against a set of exam codes to determine last medical examination dates, and against a set of procedures known to resolve each medical condition. Each condition requiring regular care is matched against any resolving procedures, leaving a set of untreated conditions requiring regular care. Based on the date of the last exam or treatment and accepted standards of care or office policies, a due date is calculated for each patient. The management system is queried for each overdue patient to determine whether they already have an appointment scheduled in the future, or a recall notice recently sent or yet to be sent. Additional filtering based on administrative settings may also be done. Overdue patients requiring contact are then placed on the contact list.

We claim as follows: 
     
         1 . A computerized method for identifying patients who are due for care so that those patients can be personally contacted by staff at a health care facility, comprising:
 automatically identifying, using billing or other encounter data from a computerized medical or dental office management system, patients with conditions requiring regular care;   automatically determining the most recent date of treatment using billing or other encounter data from the database;   automatically identifying patients who are due for care by comparing expected visit intervals for each condition with the time since last treatment, and storing these in a contact list;   automatically identifying patients who already have appointments or who will receive reminders to call for an appointment and removing these from the contact list;   displaying patient information to an operator, the patient information including at least the patient's name, telephone number, and reason why the patient is due for care;   contacting the patients by the operator; and   scheduling an appointment for healthcare while the patient is on the telephone;   in which the billing or other encounter data includes data from electronic medical records.   
     
     
         2 . The method of  claim 1  in which scheduling an appointment includes transferring the call to a scheduler. 
     
     
         3 . The method of  claim 1  further comprising displaying a screen that the operator can use to record the results of the contact. 
     
     
         4 . The method of  claim 1  further comprising removing the patient from the contact list. 
     
     
         5 . A computerized method for identifying patients who are due for care so that those patients can be personally contact by staff at a health care facility, comprising:
 automatically identifying, using billing or other encounter data from a computerized medical office management system, patients with conditions requiring regular care;   automatically determining the most recent date of treatment using billing or other encounter data from the database;   automatically identifying patients who are due for care by comparing expected visit intervals for each condition with the time since last treatment, and storing these in a contact list;   automatically identifying patients who already have appointments or who will receive reminders to call for an appointment and removing these from the contact list;   displaying patient information to an operator, the patient information including at least the patient's name, telephone number, and reason why the patient is due for care;   attempting to contact the patient by the operator;   displaying to the operator a computer screen having fields in which to enter contact results; and   automatically determining from the contact results whether to schedule a follow-up telephone call;   in which the billing or other encounter data includes data from electronic medical records.   
     
     
         6 . The method of  claim 5  further comprising displaying a screen that the operator can use to record the results of the contact. 
     
     
         7 . The method of  claim 5  in which contacting the patient includes receiving information indicating that the patient is not to be contacted and further comprising removing the patient from the contact list. 
     
     
         8 . The method of  claim 5  in which contacting the patient includes receiving information indicating that the patient has a different telephone number and further comprising attempting to contact the patient using the new telephone number and recording the telephone number in the office database. 
     
     
         9 . A computerized method for identifying and attempting to contact patients who are due for care, comprising:
 automatically identifying, using billing or other encounter data from a computerized medical office management system, patients with conditions requiring regular care;   automatically determining the most recent date of treatment using billing or other encounter data from the database;   automatically identifying patients who are due for care by comparing expected visit intervals for each condition with the time since last treatment, and storing these in a contact list;   automatically identifying patients who already have appointments or who will receive reminders to call for an appointment and removing these from the contact list; and   automatically transmitting an electronic communication to a telephone number associated with each patient on the contact list, the electronic communication including an message to the patient to schedule an appointment for health care.   
     
     
         10 . The method according to  claim 9 , further comprising eliminating from the list: patients having specific insurance, patients over a given age, patients who have not been seen for a very long time, patients seen by specific doctors or at specific location, patients who have been discharged or are in collections, or patients who are deceased. 
     
     
         11 . The method according to  claim 9  in which the electronic communication is a short message service (SMS) message. 
     
     
         12 . The method according to  claim 9  in which the electronic communication is a multimedia messaging service (MMS) message. 
     
     
         13 . The method according to  claim 9 , further comprising automatically generating recalls or mailing labels from the list to send patients written reminders to call for an appointment. 
     
     
         14 . The method according to  claim 9 , further comprising automatically generating from the list email to patients requesting the patients to call for an appointment. 
     
     
         15 - 20 . (canceled)