1. Interoperability for Patient Payments
Patient Online Bill Pay Functionality
Ray Delano
Director Revenue Cycle Management – RCM Solutions

2. Open Platform Vision
Cerner is accelerating health care innovation by enabling a broad community to amplify the power of its open platforms.
By making patient financial data interoperable, healthcare providers will be able to create a single aggregated view across disparate revenue cycle management systems.
Lifted from Open Platforms Q3 Review deck, Sam Lambson.
Modified by Ray Delano 6/26/2017

3. Patient Payment Use Cases
Online bill payments
Guest pay
Logged-in
Point of service/ back office payments
Use Cases:
Online bill payments - The ability for a guarantor to pay against their outstanding balances online.
Guest pay – A guarantor doesn’t wish to create an account and only needs a solution to retrieve their balance and make a payment.
Logged-n – A guarantor has created an account (typically using an identity management system) to manage their healthcare financials. The Logged In experience will typically be more robust than a Guest Pay experience.
Point of service and back office payments – These are payments collected by a provider user from a guarantor for healthcare services. These payments may be made in person, over the phone, or sent through the mail.

4. Online Bill Pay Workflow
Third Party Developer will call multiple FHIR resources to obtain the patient financial data.

5. Point of Service Workflow with Container
1 = The TPD app can show any data that the TPD wants to show, including balances from other RCMs and combined payment plans. Actions in the TPD app can be performed according to the functionality of that application – e.g. setting up a payment plan.
2 = Payment can be of whatever type the TPD supports – e.g. credit card, ACH
3 = TPD has to split any payments that cross RCMs in this step – posting to Cerner system only amounts to be applied to encounters in Cerner systems.

6. Patient Financial Data
Supported FHIR resources for reads and writes
Account
Encounter
ChargeItem
Patient
RelatedPerson
GAP in FHIR resources
Balance
Payment
Adjustment
Statement
Gaps:
Balance: Need a way to express the current balance amount(s) owed by the responsible parties of the account.
Examples: Primary, secondary and tertiary insurance balances and self-pay balance
Payment: Need a way to represent the insurance payments and patient/guarantor payments that have been made against a referenceable resource. ie: account, chargeItem, etc..
Examples: Insurance payments, copays, self-pay payments, pre-service payments
Adjustment: Need a way to represent the different adjustments that can be applied to lower or raise an account balance.
Examples: Contractual adjustments, self-pay discounts, early payment discounts
Statement: Need a way to represent the patient billing statement data externally. A statement is a presentation of the total amount owed for one or more receivables by the patient, guarantor, or organization at a given point in time. The statement consolidation method chosen by the issuing organization will dictate the grouping or ungrouping of receivables on a statement.
Examples: Patient billing statement, organizational billing statement

7. Filling the Gaps New FHIR resource for the financial model
FinancialTransaction
Updates to existing FHIR resources
Account
Balance – reintroduce field
RelatedParts – new field
State - new field
PartOf – cardinality change
PresentedForm - new field
Encounter – new field
Search by Guarantor – new parameter
ChargeItem
Amount – new field
FinancialTransaction
Cerner has designed and implemented a resource on Basic for sharing payment and adjustment data associated to a patients account.
The resource was designed based on the following:
HL7 Detail Financial Transaction (DFT) spec – The FT1 segment of this spec contains information necessary to post payments and adjustments to patient accounts.
The Payment FHIR resource drafted by the FM group in the summer of 2018
Input from potential developers like InstaMed, Experian, Simplee, Commerce Bank, ect…
Tracker# – Request for a new resource to post payment to patient accounts.
Updates to Existing FHIR Resources:
We believe the following updates to existing resources would allow the FHIR spec to support patient payment use cases.
Account
Balance – Reintroduce this field so balances can be shared – Tracker# 20972
RelatedParts – Introduces non-parent relationships to other account entities - Tracker# 20997
State – New field that represents more of a functional business status of an account - Tracker# and 20496
PartOf – Change in cardinality to allow an account to be part of more than one account - Tracker# 20994
PresentedForm – Introduces a Binary link to a document representing that account; ex: patient statement image - Tracker#20998
Encounter – Account should reference encounter instead of encounter referencing account – Tracker# 17671
Search by Guarantor – Ability to search for accounts that are the guarantors responsibility. - Tracker# 20970
ChargeItem
Amount – Represents a monetary amount of the charge – Tracker# 21001

8. Contacts
For more information: Alex Beckner Tricia Chitwood Ray Delano