Chair: Viet Nguyen, Yan Heras
Scribe: Phung Matthews
Minutes Approved as Presented
This is to approve minutes via general consent. "You have received the minutes. Are there any corrections to the minutes? (pause) Hearing none, if there are no objections, the minutes are approved as printed."
Meeting Minutes from Discussion
|Decision Link(if not child)|
|Management||Review ANSI Anti-Trust Policy|
The meeting on July 22nd will be cancelled due to CMS Connectathon
Participant session for the CMS connectathon- at 4PM ET.
|HL7 Process Update|
FMG approved the Da Vinci Risk Adjustment FHIR IG Proposal on June 30th
Next deadline is October for the NIB- intention to Ballot.
Continue with business requirement and FHIR analysis discussion
Big thank you to Brent for preparing this HCC gap and hierarchies.
Presentation to demonstrate the subtlety of HCC and hiearchies.
Hiearchies- CMS v 24 2021- organized by clinical data
Scenarios with hierachies
If always applying hierarchies, you may lose sight of open HCC gaps that is buried due to the superceded HCC gaps and miss the opportunity to close it.
If not applying hierarchies, the HCC codes that should be superceded will continue to show up in the EHR, and only way to remove them is going in manually to close and invalidate each HCC. Brings burden onto the provider end.
This scenario will send all the gaps, open and closed. Superceded HCC codes only work on close gaps. Payer can flag the HCC codes as closed and superceded. Provider can then indicate in the filter to display which HCC gaps are left.
To be superceded, you need a higher superior gap to be closed.
Challenge- whether the payer should second guess what the provider wants to see.
Best practice to have the filtering function on the provider side. EHR/SMART on FHIR should have the capability to implement a filter.
Scenario C- will have superceding rules on the payer side, how the flags are set up will be on the payer side.
May need to have a standard on how the flags are set up as there could be many variations on the payers.
This becomes trickier when looking at HCC gaps for performance gap rules. Depending on the rule and which HCC codes are inactivated based on rules, performance rate will be affected.
Where the IG can help- if it can be used to display gaps and performance gaps and help provider have full display of HCC.
Question- are current reports displaying the contract terms regarding the HCC risk adjustment?
May need to have a request for comments during the ballot period to seek comments on the performance rules.
This is why it is imperative that we provide the provider the ability to invalidate gaps.
May be more toward the STU2.
Next week meeting will start 15 minutes later.
|Adjournment||adjourned at 04:01PM|
|Stratametrics||Dale Davidson||Rachel Foerster|
|Karl Everitt||Epic||Tim McNeil|
|BCBS Alabama||Thomson Kuhn||Leah Hannum|
|Providence St. Joseph||Patty Craig||Dave Foster|
|Nick Radov||Bryan Briegel|
|Optum||William Harty||Preston Lee|
|Centene||Deidre Sacra||Gary Dickinson|
|POCP||Jay Baker||Rob Reynolds|
|Phranil Metha||Healow||Cigna Evernorth|
|Brent Zenobia||Novillus||Travis Hendrix|
- Re-evaluate the name of this use case as "Risk Adjustment" does not define the payment aspect of the primary focus. Need to discuss with CQI WG as well.
- Add to Phase 2 - Ability to remove and provide a reason for status change. e.g. the patient no longer has the condition.