IHE Eye Care “Charge Posting” Donald Van Syckle DVS Consulting, Inc. www.dvsconsult.com

Charge Posting Profile: Features Facilitates Collection of Procedure Details for Billing Performed Procedure Technical Fees Materials Usage Future - Reporting Professional Fees Etc. Facilitates Management of Account Details in Multiple Systems and Procedure Records June, 2006

Benefits Reduces Billing Errors Ensures Complete and Consistent Data Less Billing Resource Requirements Reduces System Interface Installation Time Reduces the Need of the Billing System to Have Knowledge of Eye Care System Eliminates Redundant Data Entry and Maintains Data Integrity Provides Operational Cost-effectiveness June, 2006

RESULT Charge Processor will receive more complete, timely and accurate data. June, 2006

Types of Billing Charges Technical Charges Fees for the actual procedure Typically eligible at procedure completion Information on materials used Professional Charges Not being addressed this year, but plans to add soon Ensuring the required data is complete is the responsibility of the Charge Processor and is outside the scope of IHE and will be determined by the clinic policies June, 2006

Workflow PMS BILLING SYSTEM Acquisition Modality EMR Initial Capture of Patient Demographics Patient Information PMS Registration Account Complete BENEFITS Procedure Information Redundancy Eliminated Orders Placed Maximum Data Integrity Billing Available ASAP All Systems Updated Acquisition Modality EMR June, 2006

Technical Details HL7 Messages manage account details between systems Open, Update, Close Account DICOM Performed Procedure Step Messages (MPPS) provide details to Order Filler from the modality: Performed (Billable) Technical Activities Usage of Materials HL7 Messages allow Order Filler to post charges to the Charge Processor (financial system) June, 2006

Transaction Diagram June, 2006

Workflow Charge Processor receives patient/account information from ADT/Patient Registration An order is generated for the patient and a procedure is performed on a Acquisition Modality (part of SWF) ORM, MWL, MPPS, …… DSS/Order Filler indicates to the Charge Processor that procedures are available for billing (using HL7) Charge Posted Transaction may be sent at various times in the workflow Regulations and site policies determine when a procedure is eligible for Charge Posting June, 2006

Account Management Transaction Collects information relevant to the patient account and submits it to the Charge Processor June, 2006

Actor: ADT/Patient Registration Sends the message whenever a patient is: Pre-admitted Admitted Sends P01 event to add a new account Sends P05 (update account) event used to update an existing account Send P06 (end account) event used to close an account Optional features One or more DG1 segments - Patient’s Diagnosis One or more GT1 segments – Guarantor Information One or more IN1 segments - Insurance Information June, 2006

Message Segment: P01 - New Account BAR Segment Billing Account Chapter in HL7 2.3.1 MSH Message Header 2 EVN Event Type 3 PID Patient Identification [{DG1}] Diagnosis 6 [{GT1}] Guarantor [{IN1}] Insurance June, 2006

Message Segment P05- Update Account BAR Segment Billing Account Chapter in HL7 2.3.1 MSH Message Header 2 EVN Event Type 3 PID Patient Identification [{DG1}] Diagnosis 6 [{GT1}] Guarantor [{IN1}] Insurance June, 2006

Message Segment P06 - End Account BAR Segment Billing Account Chapter in HL7 2.3.1 MSH Message Header 2 EVN Event Type 3 PID Patient Identification June, 2006

Actor: Charge Processor Receives patient demographics, account info, etc. for ADT/Patient Registration Receives the posted charges and serves as a component of the financial system. Note: When and how the actual billing is trigger is is beyond the scope of IHE. June, 2006

Actor: Department System Scheduler /Order Filler Receives/Collects patient information through existing HL7 ADT messages (defined in SWF) Upon a defined workflow action (i.e. MPPS from modality), makes procedures info available for charge posting The actions/events that actually causes charges to post is defined by the actor Maybe convert protocol codes to CPT codes Maybe include diagnostic reasons for procedures (ICD) codes Send charge message upon receipt of MPPS or require manual confirmation Others…… June, 2006

Interaction Diagram June, 2006

HL7 DFT Message Semantics Describes a financial transaction transmitted between the DSS/Order Filler and the Charge Processor DSS/Order Filler uses information from the Modality Performed Procedure Step Completed/Discontinued transaction to verify the procedure has been completed Includes the DICOM Billing and Material Management Code Module which provides procedure, materials and devices information DSS/OF maps information from DICOM world to HL7 world The Charge Posted Transaction will transmit Detailed Financial Transactions (DFT) messages using the P03 event May convert procedure information from MPPS to CDT codes, etc. One or more PR1 segments shall be present if additional procedures, materials or devices are present (more then one modality) June, 2006

Detailed Financial Transaction Message Message Segments DFT Segment Detailed Financial Transaction Message Chapter in HL7 2.3.1 MSH Message Header 2 EVN Event Type 3 PID Patient Identification {FT1} Financial Transaction 6 [{PR1}] Procedure June, 2006

Trigger Events Procedure Ordered Procedure Scheduled Procedure Completed Future will define Report events for professional fees June, 2006

Actor: Charge Processor Receives patient demographics, account info, etc. for ADT/Patient Registration Receives the posted charges and serves as a component of the financial system. Note: When and how the actual billing is trigger is is beyond the scope of IHE. June, 2006

More information…. IHE Web site: www.ihe.net Technical Frameworks ihe_eyecare_tf_TI_vol1_2006_06_01 (Trial Implementation version) ihe_eyecare_tf_TI_vol2_2006_06_01 (Trial Implementation version) ihe_tf_rev6.0ft_vol1_2005-05-18-FINAL (Radiology) ihe_tf_rev6.0ft_vol2_2005-05-18-FINAL (Radiology) ihe_CARD_tf_vol2_2.1_FT (Cardiology) Standards used by IHE Eye Care DICOM Standard www.nema.medical.org HL7 Standard www.hl7.org IHE Connectathon Oct. 2006 at RSNA HQ IHE Showcase at Nov. 2006 AAO Conference Vendor Products Integration Statements June, 2006

June, 2006