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)|
Review ANSI Anti-Trust Policy
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|HL7 Process Update|
Project scope update name from Risk Based Coding to Risk Adjustment
PIE- reviewed on Tuesday and thought they did not have the expertise on it so moved from Co-Sponsor to interested party.
Next, Patient Care will review and determine if they will continue to be a Co-Sponsor.
Moving forward for the HL7 process. Will need to start an FHIR IG proposal as it is separate from the PSS proposal.
Data elements requirements for Risk Coding Report from Payer to Provider
Update Confluence page for supplement information and examples.
Right now as an Introductory/scope, Data Elements, Glossary and Data Flow
Goal phase 1- currently is defining standard methodology for Payers to communicate coding gaps to Providers.
Glossary - will be used to determine best terms and definition. Will come back to the permanent, persistent, acute and chronic as it may not be industry consistent use of terms.
Data Elements- use to capture the right data elements to be used in the framework of payers sending coding gaps to providers.
Today discussion- go over Example scenario for data elements
Any changes in glossary terms?
Joint commission- need to have it so it supports all risk adjustments.
RXC- model on commercial side and will use pharmacy data
RxHCC- model on medicare advantage side, will use medical data not pharmacy. Estimate of financial impact based on a medical condition
Focus on diagnosis on Medicare and help clarify that pharmacy data and procedure would be out of scope.
Focus on medical risk adjustment model starting with Medicare but can be used for commercial models.
Structurally there is no difference between HCC and RxHCC. Only difference is deciding which to send out to the providers. Same evidence can be used to close both gaps. If using both, can be redundant.
Goal- to have provider document accurate diagnoses whether it is risk adjustment or not.
Any data can be used to support the HCC category including DME.
Do you always have supporting evidence when sending historic condition?
On RA status- when stating confirmed for historic condition, is it because it is on this current year or from last year?
Pick up next week on RA status
|Adjournment||Adjourned at PM 03:57PM ET|
|BCBS Alabama||Thomson Kuhn|
|Providence St. Joseph||Patty Craig|
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