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March 11, 2016 Financial Management Work Group Conference Call

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Conference Call Schedule

  • Occurs on Fridays, 4 PM Eastern
  • Phone Number: +1 770-657-9270 Participant Passcode: 686300# (alternative for US if the first number doesn't work: +1 888-321-4501)

Attendees

Member Name
Kathleen Connor Co-chair x
Beat Heggli Co-chair
Paul Knapp Co-chair x
John Moehrke Security Co-Chair
Lorraine Constable x
Andy Stechishin x
Mark Scrimshire
Grahame Grieve
Corey Spears
Mary Kay McDaniel

Agenda

  • Approval of March 4, 2016 Financial Management Work Group Conference Call minutes
  • Mary Kay walk through of v.2 tables and discussion about v.3 CoverageType codes as the preferred HL7 vocabulary across product lines and how that might be accomplished if FM approves the notion.
  • Add additional Requirement to [FM CP 9567 Contract.signer definitionrequirements, including binding to FHIR Actor Value Set with newly approved AgentRoleType codes.
  • Deferred till next call: Discussion whether ProvenanceEvent value set needs to additional financial and administrative specific activities - e.g., process, adjudicate, pay, revoke, recind. KC to develop examples and use cases where financially specific codes may be needed.

Minutes

  • TBD Chaired
  • Reviewed and approved agenda and minutes. Paul moved, Andy seconded 4-0-0
  • Mary Kay walked us through v.2 table issues focusing on IN1:
    • Table 0086 - (User Defined Plan ID) with "Definition: This field contains the coding structure that identifies the various plan types, for example , Medicare, Medicaid, Blue Cross, HMO, etc. Refer to User-defined Table 0086 - Plan ID in chapter 2C for suggested values. (KC - there are no suggested values in Chapter 2C yet - so this is where we would need to put ActCoverageType codes)
    • Table 0309 - (User Defined Coverage Type) with Definition: This field contains the coding structure that identifies the type of insurance coverage, or what types of services are covered for the purposes of a billing system. For example, a physician billing system will only want to receive insurance information for plans that cover physician/professional charges. Refer to User-defined Table 0309 - Coverage Type in chapter 2C for suggested values. (KC - same suggested values in Chapter 2C)
    • Mary Kay and Paul discussed the double meaning of Table 0309 as both the types of services covered and as the billing form to be used. Mary Kay stated that she isn't sure how the industry is using, but surmised that the typical Practice Management System uses local codes for their business needs, and sends these v.2 Patient Billing messages to systems that generate the outbound payer transactions. Paul wasn't sure whether any entity is using these segments.
    • Question about utility of bothering to (1)disambiguate Table 0309 into 2 tables - one for billing forms, one for service type is necessary - or just more clarification that these codes could be used from both use cases, (2) bind 0086 to ActCoverageType. More informal surveying of practice management systems, billing services, and clearinghouse vendors may be helpful.
    • Decision to continue discussions on v.2 issues biweekly.
  • Discussed addition of NEW 3rd Contract.signer Requirements:
    • Current = "Contract.signer, Contract.friendly, and Contract.binding are optional. Contract.friendly, and Contract.binding may include signers and signatures. There may be one or more signers and Signatures on the Contract Resource, which includes these attachments as well. When a Contract.signer applies a signature to the Contract.binding referenced resource, then this is the documentation that is the legal source of truth.
    • When a Contract.signer is also the signer of a "friendly" form version of a contract, then the Contract.signer Signature is the legal source of truth."
    • Proposed NEW 3rd RULE: "If there is no grantor Contract.signer, and there is a grantor signature in the Contract.friendly attachment, then the Contract.friendly grantor signature is the legal signature for the Contract grantor. This business requirement arises from the practice of conveying contract terms in an online form, which the grantor electronically signs in lieu of signing a hardcopy version of substantially the same contract.".
    • Discussed need for additional:
  1. Financial and administrative activity codes for ProvenanceEvent value set[aka FHIR Activity Value Set] such as "sell, buy, offer, agree, negotiate, rescind".
  2. Financial and administrative actor codes for FHIR Agent value set.

Kathleen will draft July Harmonization with additional codes.

NOTE: Votes recorded affirmative/negative/abstain