hair: 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."
Agenda Topics
Agenda Outline | Agenda Item | Meeting Minutes from Discussion | Decision Link(if not child) |
|---|---|---|---|
| Management | Review ANSI Anti-Trust Policy | ||
| |||
| Announcement | The meeting on July 22nd will be cancelled due to CMS Connectathon Meeting today (July 15th) will start at 3:15pm ET instead of 3pm ET to accommodate the NCQA Digital Quality Summit schedule this week. | Cancellation of call next week due to CMS connectathon. You may visit the confluence page for further agenda details. | |
Discussion | Continue with business requirement and FHIR analysis discussion
| Continue discussion from last week.
Scenario A- Apply hierarchies, only send most severe.
Scenario B- no application of hierachies, send unconfirmed gaps
Scenario C= apply hierachies, flag and send all gaps
Examples of gaps
Rules are entirely set by payers but is used to help determine performance rate.
In example above, only HCC 70 will be in the performance rate, as all other HCC codes are superceded and confirmed There is a process to determine if a HCC code is validated. Need to capture a placeholder Purpose of IG- to provide HCC gaps from payers to providers or provider's entity. Not stating how payer should be performing it or how providers should be interpreted. Risk adjustment status- changing to evidence status- to indicate whether evidence is confirmed, pending or non-confirmed Question- any compliance coding individuals working right now? current blocker is not telling which HCC codes gaps are as as the diagnosis codes are being used for documenting or for claims payments. some concerns/issues is that it is leading providers to certain diagnosis. When payers is sending diagnosis code versus identifying what the HCC code gaps are. You need to be careful and explain that the suspected diagnosis code came from historic claims and data. If payers is too aggressive in sending out suspected data into the EHR, you may get push back from the providers. IG not suitable to exchange data except to validate or invalidate HCC. Most important in the data elements- if whether there are elements that would propose a challenge in sharing it and give a premise on what issues would arise if they are using the elements or if it should be omitted. Elements can also be made optional. | |
| Management | Next Agenda | Next meeting 7/29/21 | |
| Adjournment | adjourned at 04:00PM |
Attendees
Present | Name | Affiliation | Present | Name | Affiliation | Present | Name | Affiliation | ||
|---|---|---|---|---|---|---|---|---|---|---|
| Stratametrics | Dale Davidson | Rachel Foerster | ||||||||
| Karl Everitt | Epic | Tim McNeil | ||||||||
| BCBS Alabama | Thomson Kuhn | Leah Hannum | ||||||||
| Providence St. Joseph | Patty Craig | Dave Foster | ||||||||
Peter Muir | Nick Radov | Bryan Briegel | ||||||||
| Optum | William Harty | Preston Lee | ||||||||
Brian Murta | Centene | Deidre Sacra | Gary Dickinson | |||||||
| POCP | Jay Baker | Rob Reynolds | ||||||||
| POCP | Joseph Quinn | HSX | Shawn | |||||||
| Phranil Metha | Healow | Cigna Evernorth | Donielle Williams | |||||||
| MultiCare | Mariel Brechner | |||||||||
| BCBST | Christopher Marchand | Pranathi K | ||||||||
| Peter Muir | Vijay Sravani Thotakura | |||||||||
| Availity | Kira Whitworth | Angie Finley | ||||||||
| Brent Zenobia | Novillus | Travis Hendrix | Eric Liu | |||||||
| Optum | Zahid Butt | |||||||||
| Frank | Khushwinder Singh |
Action items
- 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.