Charge Posting Integration Profile

1. Charge Posting Integration Profile Rita Noumeir Ph.D. IHE Planning CommitteeIHE Technical Committee

2. Reporting Workflow Manage worklists, track status, perform & notify diagnostic reporting steps Integration Profiles Scheduled Workflow Charge Posting Admit, order, schedule, Collect and post timely billable procedure details triggers manage worklists, track status, perform & notify acquisition related steps, create, store, manage, retrieve & use images HIMSS 2003

3. OBJECTIVES • Standardize the Charge Posted Transaction to the Charge Processor • Reduce System Interface Installation Time • Between Clinical Systems and the Charge Processors • Reduce the Need of the Billing System to Have Knowledge of the Radiology Internals. HIMSS 2003

4. RESULT Charge Processor will receive more complete, timely and accurate data. HIMSS 2003

5. Types of Billing Charges • Technical Charges • Fees for the actual procedure • Typically eligible at procedure completion • Information on materials used • Professional Charges • Fees for reading by the radiologist • Typically eligible at result verification HIMSS 2003

6. Express Lane • ADT Patient Registration systems can send patient information directly to the Charge Processor • Minimizes the information needed to be sent to the Department System Scheduler/Order Filler • Insurance information • Guarantor information Note that the DSS/Order Filler may be interested in the Insurance or Guarantor Info – however… The ‘golden rule of IHE’ is to eliminate redundant/duplicate data and to provide a direct link between the ‘owner’ and consumer of data - Andrei Leontiev. HIMSS 2003

7. To Fee or Not To Fee Charge Processor may or may not receive the fees (charges) which come from: • Department System Scheduler/Order Filler or • Charge Processor Charge Processor can override the fees provided by the Department System Scheduler/Order Filler. Ensuring the required data is complete is the responsibility of the Charge Processor and is outside the scope of IHE HIMSS 2003

8. Real-time vs. Batch • IHE specifies real-time charge posted transactions • Batch processing can be accommodated • Per batch specifications defined in HL7 Chapter 2 2.23.2 Batch Protocol HIMSS 2003

9. Transaction Diagram HIMSS 2003

10. Charge Posted Transaction • Department System Scheduler/Order Filler sends descriptions of performed procedure(s) and material changes HIMSS 2003

11. Workflow • Department System Scheduler/Order Filler indicates to the Charge Processor that procedures are available for Technical and/or Professional billing • 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 HIMSS 2003

12. Scope • Specifies a message from the Department System Scheduler/Order Filler to the Charge Processor • HL7 Financial Transaction message contains procedure data typically needed to generate a claim. HIMSS 2003

13. Data Sources • Patient Order Information • Scheduling and Requested Procedure • Scheduling and Scheduled Procedure Step • Modality Performed Procedure Step • Status Information - Completed / Discontinued • Protocol Code • Consumables Optionally, additional manual input or processing by the Department System Scheduler/Order Filler HIMSS 2003

14. New Concept Chargeable Procedure • Procedure that generates a charge to be applied to a patient’s account • Corresponding charge information is sent to the Charge Processor • Managed by the Department System Scheduler/Order Filler to ensure it is accurate. HIMSS 2003

15. Use Case Roles • Department System Scheduler /Order Filler • Charge Processor HIMSS 2003

16. Use Cases • Department System Scheduler/Order Filler makes technical charges available when modality has completed the procedure • Department System Scheduler/Order Filler professional charges available at time of report verification • Site makes both technical and professional charges available at time of result verification • Site may have a single charge that comprises both the technical and professional components HIMSS 2003

17. Actor: Department System Scheduler /Order Filler • Receives/Collects patient information through existing messages • Upon a defined workflow action, makes procedures available for charge posting • The action/event that actually causes charges to post is defined by the actor HIMSS 2003

18. Actor: Charge Processor • Receives the posted charges and serves as a component of the financial system. Note: Further definition of this actor is beyond current IHE scope. HIMSS 2003

19. Interaction Diagram HIMSS 2003

20. Trigger Events • Procedure Ordered • Procedure Scheduled • Procedure Completed • Result Dictated • Result Transcribed • Result Verified Note: Events can be different for technical and professional charges. HIMSS 2003

21. Detailed Financial Transaction Message (DFT) • Describes a financial transaction transmitted between the Department System Scheduler/Order Filler and the Charge Processor. Note that sometimes the DFT does not actually result in a financial transaction. HIMSS 2003

22. HL7 DFT Message Semantics • The Department System Scheduler/Order Filler uses information from the Modality Performed Procedure Step Completed/Discontinued transaction to verify the procedure has been completed • Can include the DICOM Billing and Material Management Code Module which provides procedure, materials and devices information. The Charge Posted Transaction will transmit Detailed Financial Transactions (DFT) messages using the P03 event. • One or more PR1 segments shall be present if additional procedures, materials or devices are present. It may be absent otherwise. HIMSS 2003

23. Message Segments HIMSS 2003

24. Account Management Transaction • Messages from the ADT Patient Registration to the Charge Processor • Sent when the patient account is: • Set-up • Updated • ClosedNote: Minimizes the information sent to the Department System Scheduler/Order Filler HIMSS 2003

25. Use Case Roles • ADT Patient Registration • Charge Processor HIMSS 2003

26. Actor: ADT Patient Registration • Collects information relevant to the patient account and submits it to the Charge Processor HIMSS 2003

27. Actor: Charge Processor • Receives the information from Patient Registration • Processes and combines charges • Issues an insurance claim or patient’s billing statement. HIMSS 2003

28. Interaction Diagram HIMSS 2003

29. Trigger Events • Admission of an in-patient into a facility • Registration of an outpatient for a visit of the facility • Pre-admission of an in-patient (i.e., registration of patient information ahead of actual admission). Note: Creation of an account will result in the following Account Management message: • P01 – Add Patient Account. (professional charges) HIMSS 2003

30. HL7 BAR Message Semantics • ADT Actor generates the message whenever a patient is: • Admitted • Pre-admitted • Registered • P01 event used to add a new account • P05 (update account) event used to update an existing account • P06 (end account) event used to close an account Optional • One or more DG1 segments - Patient’s Diagnosis • One or more GT1 segments – Guarantor Information • One or more IN1 segments - Insurance Information HIMSS 2003

31. Message SegmentP01 - New Account HIMSS 2003

32. Message SegmentP05- Update Account HIMSS 2003

33. Message SegmentP06 - End Account HIMSS 2003

34. Charge Posting Integration ProfileQuestions? HIMSS 2003