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Small WG Participants:


Web meeting Info:

Join using:  Zoom Meeting - https://zoom.us/j/3965708082 | Meeting ID: 396 570 8082 | +1 929-436-2866 US (New York) | Find your local number: https://zoom.us/u/a0jZY25Ua


2020 06 02:

Attendees:  

  • Paul Knapp
  • Alex Beckner

  • Susan Langford
  • Ralph Cockrum
  • Sonya May

Agenda: 

Continue to review balance on Account

Meeting Minutes:

Introduced new comers to the work and goals of this small group session.

Discussed outstanding items around guarantors and balances.

To Do:

Need PSS reviewed by PA and FHIR Admin groups.

Decide if we need these Guarantor Segment fields represented in FHIR:

  • Credit Rating
  • Household Income
  • Household Size
  • Hire Effective Date
  • Living Dependency
  • Ambulatory Status
  • Citizenship
  • Living Arrangement
  • Financial Class

Continue to work through balances.

Next Meeting:  

 06/30/2020 - No meeting on 06/16/2020 for FHIR Dev Days or 06/23/2020 as Paul has a conflict.


2020 05 26:

Attendees:  

  • Paul Knapp
  • Alex Beckner

  • Susan Langford
  • Asher Kaplan-Dailey

Agenda: 

Continue to compare current FHIR Account Resource to V2 for Guarantor Segment

Start to look at balances on Account

Meeting Minutes:

Continued to compare current FHIR Account Resource to V2 for Guarantor Segment

  • Got through the last fields
  • Need to go back through the 8 with outstanding questions

Started discussion on what is needed for representing balances on account

Discussed the need to add amounts to ChargeItem

  • Charged Amount
  • Settled Amount
  • Balance Amount

To Do:

Need PSS reviewed by PA and FHIR Admin groups.

Review Guarantor Segment fields with open questions

Continue to work through balances

Next Meeting:  

 06/02/2020


2020 05 05:

Attendees:  

  • Paul Knapp
  • Alex Beckner

  • Jada Lewis
  • Susan Langford
  • Raymond Bohartz

Agenda: 

Continue to compare current FHIR Account Resource to V2 for Guarantor Segment

Meeting Minutes:

Continued to compare current FHIR Account Resource to V2 for Guarantor Segment

  • Stopped on Financial Class

To Do:

Need PSS reviewed by PA and FHIR Admin groups.

Finish remaining Guarantor Segment fields

Review Guarantor Segment fields with open questions

Next Meeting:  

 05/26/2020


2020 04 28:

Attendees:  

  • Paul Knapp
  • Alex Beckner

  • Chris Johnson
  • Susan Langford

Agenda: 

Continue to compare current FHIR Account Resource to V2 for Guarantor Segment

Meeting Minutes:

Continued to compare current FHIR Account Resource to V2 for Guarantor Segment

  • Stopped at the Contact Reason

To Do:

Need PSS reviewed by PA and FHIR Admin groups.

Continue to compare current FHIR Account to V2.

Next Meeting:  

 05/05/2020


2020 04 21:

Attendees:  

  • Paul Knapp
  • Alex Beckner

  • Raymond Bohartz
  • Susan Langford
  • Jada Lewis
  • Sean O'Quinn
  • Serafina Versaggi

Agenda: 

Continue to compare current FHIR Account Resource to V2 for Guarantor Segment

Meeting Minutes:

Continued to compare current FHIR Account Resource to V2 for Guarantor Segment

  • Paul confirmed Employer could be logged as a contact of Patient or as a RelatedPerson.
  • Stopped at the Protection Indicator

To Do:

Need PSS reviewed by PA and FHIR Admin groups.

Continue to compare current FHIR Account to V2.

Next Meeting:  

 04/28/2020


2020 04 14:

Attendees:  

  • Paul Knapp
  • Alex Beckner

  • Susan Langford
  • Jada Lewis

Agenda: 

Continue to compare current FHIR Account Resource to V2 for Guarantor Segment

Meeting Minutes:

Continued to compare current FHIR Account Resource to V2 for Guarantor Segment

  • May need to recommend having Guarantor represented as a Patient for the spousal relationship.
  • Stopped at Guarantor Credit Rating

To Do:

Need PSS reviewed by PA and FHIR Admin groups.

Continue to compare current FHIR Account to V2.

Next Meeting:  

 04/21/2020


2020 04 07:

Attendees:  

  • Paul Knapp
  • Alex Beckner

  • Raymond Bohartz
  • Susan Langford
  • Rick Duffy
  • Jada Lewis
  • David Riddle

Agenda: 

Compare current FHIR Account Resource to V2

Meeting Minutes:

Began comparison of R4 Account and V2.9 Mappings

  • Add Patient Account Message
    • Patient/Person - Subject
    • Visit/Encounter (FHIR Encounter points to Account)
    • Guarantor - Need to enhance to represent responsibility amount.

Meetings will switch over to Zoom going forward.

To Do:

Need PSS reviewed by PA and FHIR Admin groups.

Continue to compare current FHIR Account to V2.

Next Meeting:  

 04/14/2020


2020 03 31:

Attendees:  

  • Paul Knapp
  • Alex Beckner

  • Susan Langford
  • Rick Duffy

Agenda: 

Review change request FHIR-26601

Discuss Account and needed changes for patient payments workflows.

Meeting Minutes:

Reviewed change request FHIR-26601

Discussed the history of the Account FHIR Resource

Discussed potential enhancements.

  • Missing Balance
  • May not need FHIR-20997 depending on how we represent balances and statements in FHIR.

Financial Billing Workflow:

  • We know charges come in and are associated against an account.
  • Typically they represent what the provider intends to collect.
  • If insurance, then the charges are bundled and billed to a payer on a claim.
  • Insurance could choose to pay all of claim, more than claim, less than claim.
  • Adjustments could be made.
  • Any remaining balance could be adjusted, or billed to the guarantor

Optum has a use case for HRA/HSAs and would like to use Account.

To Do:

Need PSS reviewed by PA and FHIR Admin groups.

Need to compare current FHIR Account to V2.

Next Meeting:  

 04/07/2020


2020 03 17:

Attendees:  

  • Paul Knapp
  • Alex Beckner

  • Susan Langford
  • Jada Lewis
  • Rick Duffy
  • Siddhesh Ghag
  • Laurie Buckhardt
  • David Riddle

Agenda: 

Create change request in Jira for Financia lTransaction/Payment Reconcilliation changes

Meeting Minutes:

PSS has passed the initial FM vote and will need to go on to PA and FHIR Admin groups.

May 2020 HL7 in person WGM still unknown at this time.

Created change request  FHIR-26601 to expand scope of Payment Reconciliation to include patient payments. 

To Do:

Need PSS reviewed by PA and FHIR Admin groups.

Next Meeting:  

 03/31/2020


2020 03 10:

Attendees:  

  • Paul Knapp
  • Alex Beckner

  • Susan Langford
  • Ray Bohartz
  • Jada Lewis
  • Rick Duffy
  • Siddhesh Ghag
  • Laurie Buckhardt
  • Rachel Foerster

Agenda: 

Review examples of FinancialTransaction

Meeting Minutes:

Reviewed FinancialTransaction examples:

  • detail/allocation.type - doesn't need to be required for patient payments.
  • sub-type (source) - may need to rename.
  • reason (workflow) - may need to rename.
  • paymentIssuer - insurance example should be the insurance company that payment is done in the name of.
  • May need example of where a payment was made directly with provider vs a third party.
  • Question on representing insurance adjustments/take-backs 

To Do:


Next Meeting:  

 03/17/2020


2020 03 03:

Attendees:  

  • Paul Knapp
  • Alex Beckner

  • Susan Langford
  • Ray Bohartz
  • Jada Lewis
  • Rick Duffy
  • Sonya May
  • Serafina Versaggi
  • Robert Dieterle

Agenda: 

Continue to build/merge the FinancialTransaction resource w/ PaymentReconciliation

Meeting Minutes:

Paul wasn't able to get the PSS reviewed in the regular FM meeting. Not a huge rush at this point.

Continued to build/merge the FinancialTransaction resource w/ PaymentReconciliation

To Do:

Build out FinancialTransaction Examples (Paul and Alex)

Validate that the new structure will work for our use cases

Vote on PSS in the upcoming FM meeting

Next Meeting:  

 03/10/2020


2020 02 25:

Attendees:  

  • Paul Knapp
  • Alex Beckner

  • Susan Langford
  • Ray Bohartz
  • Jada Lewis
  • Laurie Buckhardt
  • Rick Duffy
  • Mike Cabral
  • Chris Johnson
  • Sonya May

Agenda: 

Review Project Scope Statement (PSS) for the work we are doing

Build FinancialTransaction into FHIR resource and begin the merger w/ PaymentReconciliation

Meeting Minutes:

Paul walked the group through the PSS for Accounts, Payments and Statements

  • Plan to vote on PSS in the upcoming FM meeting

Continued to build/merge the FinancialTransaction resource w/ PaymentReconciliation

  • Left name as FinancialTransaction as Payment seemed to narrow.
  • Expect some push back from FHIR on the name.

To Do:

Continue to build/merge the FinancialTransaction resource w/ PaymentReconciliation

Vote on PSS in the upcoming FM meeting

Next Meeting:  

 03/03/2020


2020 02 18:

Attendees:  

  • Paul Knapp
  • Alex Beckner

  • Rachel Foerster
  • Jada Lewis
  • Rick Duffy
  • Mike Cabral
  • Siddhesh Ghag
  • Serafina Versaggl
  • Varvara Semonova

Agenda: 

FinancialTransaction FHIR resource mapping to the V2 Financial Transaction spec.

Meeting Minutes:

The group mapped the draft FinancialTransaction resource to the V2 spec.

Mapping and notes can be found on the Financial Transaction Resource 20200218.xlsx document.

To Do:

Work to build FinancialTransaction into FHIR resource and begin the merger w/ PaymentReconciliation for 1 resource to support both Patient and Insurance payments.

Next Meeting:  

 02/25/2020


2020 01 28:

Attendees:  

  • Paul Knapp
  • Alex Beckner

  • Susan Langford
  • Raymond Bohartz
  • Tricia Chitwood

Agenda: 

More in depth review of the Account resource.

Discuss upcoming HL7 WGM in Sydney.

Meeting Minutes:

No call over the next two weeks due to WGM in Sydney. 

Paul is hoping to accomplish V2 mapping for Account and FinancialTransaction while in Sydney.

Paul reviewed the R4 Account Resource:

  • UML diagram overview
  • What is missing? Balances
  • Account is really an aggregation of all financial activity for a patient.
  • Account should point to encounters. Encounters currently point to Accounts today.

Paul stubbed out Account w/ potential changes to represent balances.

To Do:

V2 mapping for Account and FinancialTransaction

Discuss balances with a larger group

Next Meeting:  

 02/18/2020


2020 01 21:

Attendees:  

  • Paul Knapp
  • Alex Beckner

  • Kathy Salavitabar
  • Jada Lewis
  • Mike Cabral

  • Raymond Bohartz
  • Rick Duffy

Agenda: 

Review the Account resource to see if it has the necessary items to support patient payment use cases.

Meeting Minutes:

Paul walked through the elements of the R4 Account Resource:

  • Type - expense and deprecation types seem more general ledger accounting concepts.
  • Subject - patient may be the only subject relevant to patient payment workflows.
  • Guarantor - the description needs to be updated to better represent what a guarantor is.

Account - Encounter relationship currently lives on the Encounter resource.

Jada walked through Cerner's billing workflow.

  • Cerner drops chargItems to the clinical encounter and not the account.

Reviewed the ChargeItem resource.

  • ChargeItem doesn't have an amount value of the chargeItem. Tracker has been logged for this.
  • Charge line items detailed are typically only displayed on the first itemized statement.

To Do:

Think about how balances should be represented.

Next Meeting:  

 01/28/2020

      

2020 01 14:

Attendees:  

  • Paul Knapp
  • Alex Beckner

  • Susan Langford
  • Kathy Salavitabar
  • Jada Lewis
  • Mike Cabral

Agenda: 


Review potential Financial Transaction resource and how that maps to Payment Reconciliation 

Meeting Minutes:

Paul provided historical review:

  • Last few years FM has been focused on claims and reimbursements for the international space.
  • Patient Admin (PA) group took on some of the financial resources like Account with FMs help. It is time to pull some of those financial resource back to FM discussions.
  • Need for Financial Transaction to report on the movement of money between parties.
  • We can create new resources or expand existing resources to support additional capabilities and workflows.
  • Account needs attention; It is missing balance.

Paul may be the only one from the small group able to attend the WGM in Sydney.

Paul reviewed the Payment Reconciliation resource

Alex and Paul shared the Financial Transaction resource w/ Payment Reconciliation mappings and outstanding notes and questions.

  • Is there a need to accept a transaction targeted at a line item from a claim or statement without referencing the claim or statement as well?
  • Does the line item have a GUID in the source system to where that is a possibility?


To Do:

Come up with discussion topics for Paul to take to WGMs around this small group initiative:

  • Is there a need to Refer to a line item like a claim item or statement item that isn't a resource itself?

Next Meeting:  

 01/21/2020


2019 12 10:

Attendees:  

  • Paul Knapp
  • Brian Bentow
  • Alex Beckner

  • Susan Langford
  • Rachel Foerster
  • Jada Lewis

Agenda: 


Review and discuss the Accounts, Statements, Payments Use Cases and User Scenarios

Meeting Minutes:

Paul reviewed the goals of the Accounts, Statements and Payments small group.

Brian walked through the Accounts, Statements, Payments Use Cases document - https://docs.google.com/document/d/1xYNJurhMyEY8N9PdLTdQZKN_niOph7-iv_ki84YiVJA/edit?ts=5deea240

  • Payments/Financial Transactions
  • Account Inquiries
  • Patient Statements


To Do:

Define the data model for these concepts and share with the group during the next meeting.

Next Meeting:  

 12/17/2019


2019 11 19:


Attendees:

 

  • Paul Knapp
  • Brian Bentow
  • Jakeh Bradley
  • Christol Green
  • Jason Hansen
  • Jin Yang
  • Cooper
  • Susan Langford
  • Sam Sanchez
  • Sung Kim
  • Laurie Burckhardt
  • Mike Cabral
  • Tiffany Ringot


Agenda: 

Presentation on Epic Patient Billing

Meeting Minutes:

Currently in the discovery phase for the project. Input and ideas are being put together now.

Jason Hansen presented a high level overview of Epic Patient Billing

Guarantor (slide)

  • Guarantor account represents party responsible for payment of care
    • May include multiple patients
  • Balances for care/visit accumulated at guarantor level
  • Statements generated across visits/services
  • Payments can be made across visits/services
    • Don't have to pay toward a statement

Statements (slide)

Snapshot of guarantor account

  • Hospital visits
  • Professional visits
  • Professional fees
  • Insurance payments and EOB information
  • Patient Payments

Payment Plans and scheduled Payments

  • Included on statement
  • Amount due for payment plan
  • Automatic scheduled payments

Print vendor

  • Batch print generates delimited file for vendor
  • Statements imported back to Epic

Patient Payments (slide)

  • Patient Portal
    • Balance payments
    • Payment Plans
    • Copay/prepay
  • Back office
    • Electronic Remittance
    • Batch Payment Post
    • Over the phone payments
  • Time of service (kiosk or front desk)
    • Balance Payments
    • Copay/prepay
  • Web Services
    • Balance payments

To Do:

Currently in the discovery phase for the project. Input and ideas are being put together now.

Next Meeting:  

11/26/2019



2019 11 12:

Attendees:  

  • Paul Knapp
  • Brian Bentow
  • Jakeh Bradley
  • Susan Langford
  • Sam Sanchez
  • Celine Anselmina Lefebvrec
  • Rachel Foerster
  • Laurie Burckhardt
  • Mike Cabral
  • Terrance Cunningham
  • Rick Duffy
  • Siddhesh
  • Tiffany Ringot

Agenda: 

Continuation of offline discussions regarding flows for Patient Statements and Patient Payments

Meeting Minutes:

We will continue discussing the flows for Patient Statements and Patient Payments. Would like to gather from everyone what their flows are and start to build resources that will support those exchanges.

Brian and Paul are looking at current exchange systems in place for Epic and Cerner.

Brian wants to make sure he has a solid understanding of requirements before we move forward. Will start to put models together soon.

Brian presented the Cerner Ideal workflow document: (link to document will be added soon).

He worked on this with Alex Beckner and Paul Knapp.

He looked at what is currently on the Cerner website regarding Accounts and workflow for Online Bill Pay (fhir.cerner.com).

  • InstaMed tested the current workflow in the sandbox
  • Patient goes thru process to pay their bill
  • First version doesn't meet all of the objectives of the project
  • Brian walked thru high level modes of communication/options (Cerner ideal workflow document)
  • Looked at Quick Pay Code Delivery (printed statement)/Real-time API Assumptions
  • Statement Generation Request Delivery Options (Provider initiated)
  • Guest flow/Unregistered User - Online Bill Pay only
  • How to eliminate the initial Printer Statement

Next, Brian and Paul will look at workflow and technical feasibility. Once that is completed, Brian and Paul will put together data models.

To Do:

Brian and team will continue to look at workflow and technical feasibility for the Patient Statements and Patient Payments flows.

Next Meeting:  

11/19/2019


2019 10 29:

Attendees:  

  • Paul Knapp
  • Brian Bentow
  • Jakeh Bradley
  • Alex Beckner

  • Susan Langford
  • Raymond Bohartz
  • Sam Sanchez
  • Cooper Thompson
  • Durwin Day
  • Rachel Foerster
  • Laurie Burckhardt
  • Mike Cabral
  • Mary Lynn Bushman
  • Rick Duffy

Agenda: 

Review process for maturation of the Patient Statements and Patient Payment flows. 

Meeting Minutes:

Paul discussed the process for maturation of the Patient Statements and Patient Payment flows. 

  1. Review of the actors (provider/presentment - payment manager), flow and pathways of material between actors
  2. Detail the flows and the content (high-level) to support the exchange
  3. Draft the resources/profiles
  4. Repeat the same as above for payments
  5. Review full cycle information flows

Provider initiated vs patient initiated payment use cases.

Appointments vs Walk-ins scenarios

Brian reviewed the Patient Check-in and Billing Workflow & Data Model 20191028.docx

Request for terminology change from patient to guarantor. 

To Do:

Interested parties should review the discussed workflows and use cases to make sure they align with their business needs and identify anything that may be missing.

Next Meeting:  

 11/05/2019


2019 10 22:

Attendees:  

  • Paul Knapp
  • Brian Bentow
  • Jakeh Bradley
  • Alex Beckner

  • Tricia Chitwood
  • Ray Delano
  • Cooper Thompson
  • Rachel Foerster
  • Laurie Burckhardt
  • Mike Cabral
  • Susan Langford
  • Christol Green
  • Lenel James
  • Raymond Bohartz
  • Saddhesh Ghag
  • Sam Sanchez
  • Kleon Kita
  • Mary Lynn Bushman
  • Durwin Day
  • Mary Kay McDaniel

Agenda: 

Overview of the work

Overview of the existing FHIR resources

Meeting Minutes:

Paul provided an overview and background history of current FHIR Financial Module - https://www.hl7.org/fhir/financial-module.html

Initial goal for this group should be to Identify flows for:

  • Statement/ bill presentment
  • Collecting of Account/ payment information and providing payment details back to the provider.

Brian gave an overview of the problem and reviewed high level flows:

Problem Statement:

Lots of paper statements today. No consolidated view. Would like to get to a Centralized Patient Account Ledger

Patient Statements Workflow and Data Model flows - Patient Statements Workflow & Data Model 20191028.docx

  • Use case 1. In house printing and portal.  Practice Management/RevCycle system is managing in house.
  • Use case 2. Practice Management outsources to a Print Vendor for statements, but keeps portal for bill pay experience in house.
  • Use case 3. Outsourced Portal and Print/Mail Practice Management outsources to a Print Vendor and portal vendor for statements and bill pay.

Patient payments flow -  Patient Check-in and Billing Workflow & Data Model 20191028.docx

Payment Plan/ Recurring payments/ Installments flow

Additional considerations:

  • What about once the account has gone past the dunning intervals and has moved to collections?
  • Collection agencies may need to be notified that a payment has been made against the account or that it is in good standing.
  • The providers patient account should be the system of record.
  • Some systems may flag certain individuals as don't move through the dunning process. (Dr's. Wife example)
  • Statement generation would be a push

  • Account balance would be a pull

To Do: Need project overview/scope added to our Accounts, Invoices, Payments, and Statements page.

Next Meeting:  

10/29/2019 




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