2022-06-01 Burden Reduction (CRD/DTR/PAS) Wednesday Meeting

Call Structure

1. Burden Reduction (CRD/DTR/PAS) - Wednesday at 11am ET 

2. Burden Reduction (CRD/DTR/PAS) - Friday at 3pm ET 

Zulip: https://chat.fhir.org/#narrow/stream/259713-DaVinci-Burden.20Reduction.20interoperability 

CMS HL7 Virtual Connectathon - July 2022

Date: July 19-21, 2022    

Registration:  https://www.surveymonkey.com/r/56MXVRF (Closes June 30)

Location:  Virtual

Track Page: CMS 2022 - 07 Da Vinci Burden Reduction (BR) Track - Expect track page changes based on Track lead Session yesterday.

Need Testers to coordinate in advance and demonstrate interoperability during the event.  Opportunity for Implementers to demonstrate capabilities. Sign Up here: Planning Demos Schedule- CMS HL7 Virtual Connectathon - July 2022

Appropriate system action change.  

Ballot Comments reported by Hans Buitendijk (4 marked for In Person Review)

Proposed list of CRD tickets ready for this call.

https://jira.hl7.org/browse/FHIR-36512 Accuracy section revision

https://jira.hl7.org/browse/FHIR-36509 will CRD Clients be informed of failure to meet the complete documentation requirements?

https://jira.hl7.org/browse/FHIR-36502 delete phrase 'starting a patient visit'

https://jira.hl7.org/browse/FHIR-36477 Add codes

https://jira.hl7.org/browse/FHIR-36474 CPT copyright year

https://jira.hl7.org/browse/FHIR-36471 Suggest adding to overview (note: this overlaps with 36477

If Reporter above is not available, we could discuss the following:

https://jira.hl7.org/browse/FHIR-36189 Da Vinci CRD ignores service-type based delegation by payer

https://jira.hl7.org/browse/FHIR-36187 Where the spec does not specify, it must not mandate

Examples like changes in coverage between when the PA is approved and when the patient receives the service. 

We want to reduce burden and get patients care. The change in the sentence 

Points made:

1) This IG cannot change behavior about circumstances changing in the real world, payer policy, or policy. 

2) the sentence as written is too broad and implies that anything can change, thus minimizing the value of the IG for Prior Auth and it's purpose to reduce burden on patients. 

The proposed wording is better. removed the addition about the fax/phone - not needed.  

Reviewed and approved. 

FHIR-36509 - Getting issue details... STATUS - Bob and Lloyd discussed, 

If the CRD app is unable to return a response, is it required to launch DTR? 

Answer: No.  DTR is not required for CRD.  The expectation is that CRD is aware of what DTR can and can't do.  e.g if you are making a referral, (can't make a decision) then it should know if there is a DTR app for that service to be able to launch it.  

• The CRD app is saying Prior Auth may be required, ideally, launches DTR.  short term, may be a link to a policy page/older process page for Prior Auth Submission or documentation that is required for coverage. 

Reviewed and approved. 

FHIR-36502 - Getting issue details... STATUS - Discussed scenarios where it makes sense that CRD would be started at the time of a Patient visit, e.g. Admitting a patient. 

Action to create a new encounter would trigger CRD and then CRD would come back and say, by the way, we require Prior Auth. 

Pick up here next week.  

Side bar question on order sign.  Wouldn't we want to do it sooner? You could - at Order select. 

Could you recheck for eligibly or re-trigger PR when the service is closer?  

Payers have regular Prior Auth policy changes and they would communicate and share. 

AMA resource - collected policy changes on Prior Auth during covid: https://www.ama-assn.org/system/files/2021-01/prior-auth-policy-covid-19.pdf

• CRD  STU 1.0.0
• DTR STU 1.0.0
  • Reference Implementation: https://github.com/HL7-DaVinci/dtr 
• PAS  STU 1.0.0

CRD / DTR Supplemental Guide

Dawn Duchek

Smile CDR