Financial Management
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Possible Scope:  (from previous discussions and draft PSS that was never submitted):

Anesthetist often provide their services at locations other than the anesthetist’s administrative offices. To support billing for their services clinical and administrative data from the servicing location must be gathered and provided to the Anesthetist’s billing location. This information is currently captured by either the servicing location EMR and/or the attending Anesthetist manually in a variety of formats. This project is to identify the information required and define a standard for it’s exchange.

Use Case(s) Supported:

  • Anesthesia information from EHR to external provider billing service (could be the office of the Rendering Anesthetist or billing service) to support billing for the anesthetist services.
  • Rendering anesthetist performs service at Hospital A. The hospital bills the surgical expenses to the patient or patient’s insurer. The anesthetist bills the patient or submits a claim to the patient’s insurer for his/her services. The anesthetist does not provide equipment or medications. Multiple services could be provided by the anesthetist during one surgical procedure (delivery or encounter/event).

This project will:

  • Identify information needs (data elements) and create a Domain Analysis Model (DAM) to facilitate consistent usage across product families within HL7
  • Map information model to FHIR Resources (to help inform the information model itself)
  • Create a FHIR Implementation Guide

Documents


FYI websites for instructions on how to bill Anesthesia Claims in the US:

https://www.horizonblue.com/providers/policies-procedures/policies/reimbursement-policies-guidelines/reimbursement-and-billing


Small WG Participants:



  File Modified
Microsoft Word Document Anes Billing PSS 170824.docx May 01, 2019 by Mary Kay McDaniel
Microsoft Excel Spreadsheet FM Anes Bill 2018 05 14 review with GAS.xlsx May 01, 2019 by Mary Kay McDaniel
Microsoft Word Document FM FHIR Accounting and Billing Data Elements for Anesthesia Billing 2017 08 24.docx May 01, 2019 by Mary Kay McDaniel
Microsoft Word Document FM FHIR Accounting and Billing Data Elements for Anesthesia Billing 2017 08 10.docx May 01, 2019 by Mary Kay McDaniel
Microsoft Word Document FM FHIR Charge Contract.docx May 01, 2019 by Mary Kay McDaniel
Microsoft Word 97 Document anestcms_m00.doc May 30, 2019 by Mary Kay McDaniel
PDF File R3747CP.pdf May 30, 2019 by Mary Kay McDaniel
PDF File anesthesia_pay_and_bill.pdf May 30, 2019 by Mary Kay McDaniel
PDF File COMM-Anesthesia-Policy.pdf May 30, 2019 by Mary Kay McDaniel
Microsoft Excel Spreadsheet FM Anes Bill 2019 06 17.xlsx Jun 17, 2019 by Mary Kay McDaniel
Microsoft Word Document Anes Billing PSS 2019 06 17.docx Jun 17, 2019 by Mary Kay McDaniel
Microsoft Word Document Practitioner and Care Team.docx Sep 11, 2019 by Mary Kay McDaniel
Microsoft Word Document Milestone Events and Categories of Anesthesia Technique.docx Sep 11, 2019 by Mary Kay McDaniel

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4 Comments

  1. Cooper Thompson

    Are we planning to focus on FHIR or v2 for this?  I was thinking v2 would be the primary focus, though rolling it into FHIR make sense.

  2. Mary Kay McDaniel

    I added two documents and a website for payer instructions for how to bill an anesthesia claims - FOR THE US. May help in informing our work.

  3. Mary Kay McDaniel

    Cooper, 

    The existing PSS which was started and not moved forward was FHIR focused.


  4. Cooper Thompson

    I think we might want to consider FHIR vs. HL7v2 (or both).  There is already a lot of infrastructure and common practice around communicating charges via v2.  And selfishly Epic already has a very mature set of HL7v2 charge interfaces developed.  Also, typically this sort of exchange fits the messaging model very well, rather than the REST API model, and messaging is still fairly immature in FHIR.  I think there are a lot of benefits to just adding anesthesia data to existing v2 charging exchanges.  (I'm not opposed to also adding them to FHIR though).

    I am interested in what the anesthesia billing companies think.  Ben was going to reach out to a few to see if they wanted to join one or two initial requirements defining calls.  If they all prefer FHIR, I can be convinced to change my mind.  However it is likely Epic would actually be able to develop a v2 solution faster (because our FHIR dev team has a huge backlog, and is they are a smaller group than our v2 team).