1. June, 2006What IHE Delivers 1 IHE Workshop 2006 - Changing the Way Healthcare Connects Donald Van Syckle DVS Consulting, Inc. Jim Riggi, CTO Medflow, Inc. Co-Chair IHE Eye Care Technical Committee IHE Eye Care “Charge Posting”

2. June, 2006 2 Charge Posting Profile: Features Facilitates Collection of Procedure Details for Billing Performed Procedure Technical Fees Performed Procedure Technical Fees Materials Usage Materials Usage Future - Reporting Professional Fees Future - Reporting Professional Fees Etc. Etc. Facilitates Management of Account Details in Multiple Systems and Procedure Records

3. June, 2006 3 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

4. June, 2006 4 RESULT Charge Processor will receive more complete, timely and accurate data. Charge Processor will receive more complete, timely and accurate data.

5. June, 2006 5 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

6. June, 2006 6 Workflow BENEFITS Initial Capture of Patient Demographics BILLING SYSTEM Patient Information Account Complete Procedure Information EMR Redundancy Eliminated All Systems Updated Maximum Data Integrity Billing Available ASAP PMS Registration Orders Placed Acquisition Modality

7. June, 2006 7 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)

8. June, 2006 8 Transaction Diagram

9. June, 2006 9 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

10. June, 2006 10 Account Management Transaction Collects information relevant to the patient account and submits it to the Charge Processor and submits it to the Charge Processor

11. June, 2006 11 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 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

12. June, 2006 12 Message Segment: P01 - New Account BAR SegmentBilling AccountChapter in HL7 2.3.1 MSHMessage Header2 EVNEvent Type3 PIDPatient Identification3 [{DG1}]Diagnosis6 [{GT1}]Guarantor6 [{IN1}]Insurance6

13. June, 2006 13 Message Segment P05- Update Account BAR SegmentBilling AccountChapter in HL7 2.3.1 MSHMessage Header2 EVNEvent Type3 PIDPatient Identification3 [{DG1}]Diagnosis6 [{GT1}]Guarantor6 [{IN1}]Insurance6

14. June, 2006 14 Message Segment P06 - End Account BAR SegmentBilling AccountChapter in HL7 2.3.1 MSHMessage Header2 EVNEvent Type3 PIDPatient Identification3

15. June, 2006 15 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.

16. June, 2006 16 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……

17. June, 2006 17 Interaction Diagram

18. June, 2006 18 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)

19. June, 2006 19 Message Segments DFT SegmentDetailed Financial Transaction MessageChapter in HL7 2.3.1 MSHMessage Header2 EVNEvent Type3 PIDPatient Identification3 {FT1}Financial Transaction6 [{PR1}]Procedure6

20. June, 2006 20 Trigger Events Procedure Ordered Procedure Scheduled Procedure Completed Future will define Report events for professional fees

21. June, 2006 21 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.

22. June, 2006 22 More information…. IHE Web site: www.ihe.net 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 www.nema.medical.org  HL7 Standard www.hl7.org www.hl7.org IHE Connectathon Oct. 2006 at RSNA HQ IHE Showcase at Nov. 2006 AAO Conference Vendor Products Integration Statements

23. June, 2006 23