2023-04-28 Patient Cost Transparency Meeting

Welcome back and Welcome any newcomers! 

On 4/28, we will have our Connectathon Kick off the last 30min of this call. 

PCT WGM+ Session

Wednesday, May 10th, 1:45-3:00 CT

HL7 Da Vinci Project: Risk Adjustment IG / Patient Cost Transparency

· Vanessa Candelora, Senior Consultant, Point-of-Care Partners

May Ballot Cycle 

• Commenting and voting happening now through May 1, 2023
• Da Vinci Risk Adjustment Implementation Guide is included

Need help navigating? Review the HL7 Balloting Resources for Da Vinci Newcomers

Thank you so much for all your participation to reach this major milestone!

1) Ask for any feedback here: Slides 19 - 20 Steps 4a and 4b (the GFE request notification and response from co-providers)

3) Review the GFE response - based requirements on the CMS form.

VC gave background for new participants.

SN: This scenario assumes that the hospital is the convening provider. Not sure it is clear how one determines who the convening provider will be. Not clearly defined in the regulation.

VC: Should we do a scenario where the surgeon is the convening provider?

Group agrees that we should.

ER: If we're looking at an out of network provider or a provider that needs to connect with an out of network payer, would there need to be a BAA (Business Associate Agreement) to conform to HIPAA or would it be enough to say that as the company providing the API we are in conformance and have appropriate security to conduct patient health information across established FHIR endpoints between us and the provider? Example, established patient with a primary care provider (convening provider) and they are trying to reach an out of network anesthesiologist.

SN: I think the transaction and the exchange of information is okay.

DS: Agree because it is for treatment. This scenario is for an uninsured patient.

Data Requirements - Step 5 (slide 21)

VC: Does it make sense for the co-providers to echo back the patient info? In our example its when the anesthesiologist would be giving the GFE information back to the convening provider through the coordination platform. Necessary or nice to have?

ZW: Nice to have.

VC: Any challenges with Step 5 that we haven't thought of?

MD: I think as long as the service linking identifier uniquely identifies the GFE back from the co-provider/co-facility, that is the assurance that it is the estimate for that patient.

Homework: Pleases review the attached deck and give us feedback on the work we've done to date.

Recording of Connectathon Kick off

You 9:05 AM
Today's Agenda https://confluence.hl7.org/display/DVP/2023-04-28+Patient+Cost+Transparency+Meeting
Viet Nguyen  to  Everyone 9:05 AM
Working group meeting PLUS agenda - https://hl7.my.site.com/LightningMemberPortal/s/lt-event?id=a1Y7V00000YrACtUAN#/PLUS-Agenda
Wed: Q31:45 pm – 3:00 pm WGM+ HL7 Da Vinci Project: Risk Adjustment IG / Patient Cost Transparency Accelerator Working SessionsDa VinciWGM+ · Vanessa Candelora, Senior Consultant, Point-of-Care Partners HL7 Da Vinci Project: Risk Adjustment IG
rick.geimer  to  Everyone 9:07 AM
Connectathon kickoff slides now posted to today's call agenda page.
You  to  Everyone 9:07 AM
1:45-3:00 pm WGM+ HL7 Da Vinci Project: Risk Adjustment IG / Patient Cost Transparency Accelerator Working SessionsDa VinciWGM+ Fulton · Vanessa Candelora, Senior Consultant, Point-of-Care Partners HL7 Da Vinci Project: Risk Adjustment IG  Patient Cost Transparency - Vanessa Candelora
Viet Nguyen  to  Everyone 9:08 AM
Virtual registration is also discounted
You  to  Everyone 9:08 AM
This session is Wednesday, May 10th.
Vanessa Candelora (POCP)  to  Everyone 9:08 AM
Find the PCT STU1 here:  http://hl7.org/fhir/us/davinci-pct/
Rachel Foerster (RFA Ltd)  to  Everyone 9:09 AM
Viet, I'm confused re your reference to virtual registration - virtual for what?
jamie parker (AEGIS.net)  to  Everyone 9:10 AM
I am new to this group but not new to HL7 WG meetings
Rachel Foerster (RFA Ltd)  to  Everyone 9:14 AM
Never mind Viet. I am registered and have the agenda.
Stanley Nachimson, Nachimson Advisors 9:25 AM
Regarding the BAA question - if your company is representing the health plan, you should have your BAA with the plan.  Not sure you need a BAA with an OON provider; you are simply setting up a communication protocol, much as you are emailing them.

Viet Nguyen 9:31 AM
The term "period of care" made me ask if we had a reference. I found this - https://www.lawinsider.com/dictionary/period-of-care It references this document - https://evolutionmedicalassociates.com/wp-content/uploads/2022/01/HHS-notice-GOODFAITHESTIMATES-SELFPAY.pdf

Mike Denison, Optum 9:31 AM
https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Guidance-Good-Faith-Estimate-Patient-Provider-Dispute-Resolution-Process-for-Providers-Facilities-CMS-9908-IFC.pdf
Chris Cioffi (Elevance Health) 9:32 AM
Need to drop for an internal call

Viet Nguyen 9:33 AM
Like a good terminologist...just create new terms!

Vanessa Candelora (POCP) 9:43 AM
If you are planning to attend the Connectathon PCT track, please let me know (privately if needed) what your interest is for testing, code you plan to bring, or just observing. We can pair testing partners and prepare the RI for testing with you.
You 9:49 AM
PCT FHIR Connectathon Track 2023 - 05 Da Vinci Patient Cost Transparency

Viet Nguyen 9:55 AM
Lots of great breakout too for observers
Viet Nguyen 9:56 AM
Also there's a Da Vinci Wrap-up on Sunday at 4pm

Viet Nguyen 9:57 AM
If you're new to the in person meeting, please find me and say hi!

Continuous Integration Build IG: https://build.fhir.org/ig/HL7/davinci-pct/

Github: https://github.com/HL7-DaVinci/test-pct-payer

Zulip for FHIR Community to share feedback: https://chat.fhir.org/#narrow/stream/301151-Da-Vinci.20PCT

PCT JIRA Dashboard (Ballot and other IG Comment Tracking): https://jira.hl7.org/secure/Dashboard.jspa?selectPageId=14010

Aditya Pattnaik 

Jackie Hemenway

Alexandra Mugge

Patrick Edwards

James Pittman

Jaime Lampshire

@Jamie Hermansen

Rachel Foerster & Associates, Ltd. (RFA)

Anoop Mohemmed

Rahul Dewal

Jeff Helman

Ranah Anan

Jeff Mincher

Balaji Narayanan

Beth Davis

Jill Elder

HCA Healthcare

Weill Cornell Medicine

Josh Loria

Sampath Jayaprakash

Kaitlin Powers

Sarah Cutcliffe

Karen Roswon

Scott Haselton

Kassie Mintesnot

Scott Weinberg

Kathy Trubisky

Kayla Heath

Shawn Wilson

Kendra May

Shouray

Kenny W

Soham Chakraborty

Crystal Ponder

Lora Redden

David Potochniak

Teresa McSpadden

Don Quackenbush

Mary McKee

Elissa Dines

Tom Frame

Meryl Bloomrosen

Emily Ames

Travis Higgins

Erin McCarthy

Virgil Bretz

Wendi Moy Akin

Heather McComas

Navaya Kadam

Nick Radov