March 15, 2012 Financial Management Work Group Conference Call

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FM Meeting Minutes

Conference Call Schedule

• Interim call Thursday March 15, 2012 @ 12:00 pm, Eastern Standard Time (New York, GMT-04:00)
• Phone Number: +1 770-657-9270 Participant Passcode: 686300# (alternative for US if the first number doesn't work: +1 888-321-4501)

March 15, 2012 Call Agenda

• Roll call; Agenda Review and Approval
• Review and Approve Meeting Minutes from WGM
• Updates on claim attachment Query Message, Chapter 5
• Discuss (after review of pertinent documents) how FM can support HITECH requirements
• Review
• Adjourn

Attendees

• Mary Kay McDaniel Co-chair
• Kathleen Connor Scribe
• Jim Whicker

Minutes

• Agenda approved: Review and approval of San Antonio WGM minutes; HITECH Self-pay provisions
• San Antonio WGM minutes were review and augmented. Mary Kay moved to approve; Jim seconded. Motion passes. Vote: 2-0-0
• Discussed HITECH Self-pay provisions and HL7 standards support. Kathleen explained that the document includes the statutory and regulatory text, ONC Data Segmentation for Privacy HITECH Self-pay use case, and additional commentary and background. Mary Kay and Jim Whicker provided insights about the X12 transactions that would be required to be exchanged in this use case between the provider and the payer.
  • If the patient has self-paid and requested that the provider not disclose information related to the self-paid service to the payer, then the provider cannot send any HIPAA transactions that include information about that service(s). For example, self-paid service information cannot be included in an Eligibility Inquiry (X12 270) requesting coverage information; a Prior Authorization Request (X12 278); a Claim (X12 837); or in a claims attachments (wrapped in an X12 275 response) in response to a payer request for additional information (X12 277) related to a Claim or a Prior Authorization.
  • Jim pointed out that most large providers have multiple EHRS and Account Receivable systems (AR), and that patient accounts are typically organized around an encounter. For example, the encounter identifier linked to a patient’s billing account may be encoded on the wristband that hospitals often attach to patients’ wrists in order to confirm identity and to bill the correct patient account. If the patient self-paid for some but not all of the services during an encounter, then the patient would have two patient billing accounts, and perhaps two encounter IDs on the patient’s wrist band and two encounters in the patient’s EHR record. Each service provider would have to decide which encounter each service is related to and which patient billing account to invoice for the service charge. Given the multiple EHRs and ARs at many institutional providers, the burden for retooling would be extensive. In the alternative, a provider might flag the encounter of a patient who is self-paying so that it is not automatically sent to the claims processing system. The account would be handled manually if the patient is paying for a subset of services received during the episode of care. This would require additional provider billing staff resources.
  • Jim offered to bring this topic up with other providers who are involved in provider accounting and billing policy discussions. We agreed that FM would appreciate an opportunity to discuss the business impacts with stakeholder communities. FM will host a series of calls for providers, payers, and policy makers in preparation for analyzing the current HL7 v.2 and v.3 standards support and gaps for the HITECH self-pay provisions.

Action Items

• Mary Kay will post the approved San Antonio Minutes on HL7 FM page
• Kathleen will post minutes
• Jim will request meeting with provider stakeholders about HITECH Self-pay provisions

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• Meeting was adjourned at 12:55 Eastern

Next meeting

HITECH Self-pay call schedule TBD Thursday May 3, 2012 prior to Vancouver WG Meeting Return to FM WG Wiki