Charge Posting Integration Profile Rita Noumeir Ph.D. IHE Planning Committee IHE Technical Committee.

Charge Posting Charge Posting Integration ProfileIntegration Profile

Rita Noumeir Ph.D.Rita Noumeir Ph.D.IHE Planning CommitteeIHE Planning CommitteeIHE Technical CommitteeIHE Technical Committee

HIMSS/RSNA HIMSS 2003

Integration ProfilesIntegration ProfilesScheduled Workflow

Admit, order, schedule,

manage worklists,

track status, perform &

notify acquisition

related steps,

create, store,

manage, retrieve &

use images

Reporting Workflow

Manage worklists, track status, perform

& notify diagnostic

reporting steps

ChargePosting

Collect and post timely

billable procedure

details

triggers

HIMSS/RSNA HIMSS 2003

OBJECTIVESOBJECTIVESStandardize the Charge Posted

Transaction to the Charge ProcessorReduce System Interface Installation

Time – Between Clinical Systems and the Charge

ProcessorsReduce the Need of the Billing System

to Have Knowledge of the Radiology Internals.

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RESULTRESULT

Charge Processor will receive more complete, timely and accurate data.

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Types of Billing ChargesTypes of Billing Charges

Technical Charges– Fees for the actual procedure– Typically eligible at procedure completion– Information on materials used

Professional Charges – Fees for reading by the radiologist– Typically eligible at result verification

HIMSS/RSNA HIMSS 2003

Express LaneExpress Lane ADT Patient Registration systems can send

patient information directly to the Charge Processor

Minimizes the information needed to be sent to the Department System Scheduler/Order Filler – Insurance information– Guarantor information

Note that the DSS/Order Filler may be interested in the Insurance or Guarantor Info – however…

The ‘golden rule of IHE’ is to eliminate redundant/duplicate data and to provide a direct link between the ‘owner’ and consumer of data - Andrei Leontiev.

HIMSS/RSNA HIMSS 2003

To Fee or Not To FeeTo Fee or Not To Fee

Charge Processor may or may not receive the fees (charges) which come from:– Department System Scheduler/Order Filler or– Charge Processor

Charge Processor can override the fees provided by the Department System Scheduler/Order Filler.

Ensuring the required data is complete is the responsibility of the Charge Processor and is outside the scope of IHE

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Real-time vs. BatchReal-time vs. Batch

IHE specifies real-time charge posted transactions

Batch processing can be accommodated– Per batch specifications defined in HL7

Chapter 2 2.23.2 Batch Protocol

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b

36: Account Management

Pt Registration: 1 Pt Update: 12

ADT

35: Charge Posted

Charge Processor

Acquisition Modality

Performed Procedure

Step Manager

6: Modality PPS in Progress 7: Modality PPS Completed

6: Modality PPS in Progress 7: Modality PPS Completed

DSS/Order Filler

Transaction DiagramTransaction Diagram

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Charge Posted Charge Posted TransactionTransaction

Department System Scheduler/Order Filler sends descriptions of performed procedure(s) and material changes

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WorkflowWorkflow

Department System Scheduler/Order Filler indicates to the Charge Processor that procedures are available for Technical and/or Professional billing

Charge Posted Transaction may be sent at various times in the workflow

Regulations and site policies determine when a procedure is eligible for Charge Posting

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ScopeScope

Specifies a message from the Department System Scheduler/Order Filler to the Charge Processor

HL7 Financial Transaction message contains procedure data typically needed to generate a claim.

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Data SourcesData Sources

Patient Order Information– Scheduling and Requested Procedure – Scheduling and Scheduled Procedure Step

Modality Performed Procedure Step– Status Information - Completed / Discontinued– Protocol Code– Consumables

Optionally, additional manual input or processing by the Department System Scheduler/Order Filler

HIMSS/RSNA HIMSS 2003

New Concept New Concept Chargeable ProcedureChargeable Procedure

Procedure that generates a charge to be applied to a patient’s account

Corresponding charge information is sent to the Charge Processor

Managed by the Department System Scheduler/Order Filler to ensure it is accurate.

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Use Case RolesUse Case Roles1. Department System Scheduler /

Order Filler2. Charge Processor

ChargePosted

DSS/OrderFiller

ChargeProcessor

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Use CasesUse Cases Department System Scheduler/Order Filler makes

technical charges available when modality has completed the procedure

Department System Scheduler/Order Filler professional charges available at time of report verification

Site makes both technical and professional charges available at time of result verification

Site may have a single charge that comprises both the technical and professional components

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Actor: Actor: Department System Department System Scheduler /Order FillerScheduler /Order Filler

Receives/Collects patient information through existing messages

Upon a defined workflow action, makes procedures available for charge posting

The action/event that actually causes charges to post is defined by the actor

HIMSS/RSNA HIMSS 2003

Actor: Actor: Charge ProcessorCharge Processor

Receives the posted charges and serves as a component of the financial system.

Note: Further definition of this actor is beyond current IHE scope.

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Interaction DiagramInteraction Diagram

ChargeProcessor

DSS/OrderFiller

Charge Posted

DFT^P03

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Trigger EventsTrigger Events

Procedure Ordered Procedure Scheduled Procedure Completed Result Dictated Result Transcribed Result Verified

Note: Events can be different for technical and professional charges.

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Detailed Financial Transaction Detailed Financial Transaction Message (DFT)Message (DFT)

Describes a financial transaction transmitted between the Department System Scheduler/Order Filler and the Charge Processor.

Note that sometimes the DFT does not actually result in a financial transaction.

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HL7 DFT Message HL7 DFT Message SemanticsSemantics The Department System Scheduler/Order Filler uses

information from the Modality Performed Procedure Step Completed/Discontinued transaction to verify the procedure has been completed

Can include the DICOM Billing and Material Management Code Module which provides procedure, materials and devices information.

The Charge Posted Transaction will transmit Detailed Financial Transactions (DFT) messages using the P03 event.

– One or more PR1 segments shall be present if additional procedures, materials or devices are present. It may be absent otherwise.

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Message SegmentsMessage SegmentsDFT Segment Detailed Financial Transaction

MessageChapter in

HL7 2.3.1

MSH Message Header 2

EVN Event Type 3

PID Patient Identification 3

{FT1} Financial Transaction 6

[{PR1}] Procedure 6

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Account Management Account Management TransactionTransaction

– Messages from the ADT Patient Registration to the Charge Processor

– Sent when the patient account is: Set-up Updated Closed

Note: Minimizes the information sent to the Department System Scheduler/Order Filler

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Use Case RolesUse Case Roles1. ADT Patient Registration

2. Charge Processor

AccountManagement

ADT PatientRegistration

ChargeProcessor

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Actor: Actor: ADT Patient RegistrationADT Patient Registration

Collects information relevant to the patient account and submits it to the Charge Processor

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Actor: Actor: Charge ProcessorCharge Processor

Receives the information from Patient Registration

Processes and combines charges

Issues an insurance claim or patient’s billing statement.

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Interaction DiagramInteraction Diagram

BAR^P01, P05, P06

ChargeProcessor

ADT PatientRegistration

Account Management

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Trigger EventsTrigger Events Admission of an in-patient into a facility Registration of an outpatient for a visit of

the facility Pre-admission of an in-patient (i.e.,

registration of patient information ahead of actual admission).

Note: Creation of an account will result in the following Account Management message:– P01 – Add Patient Account. (professional charges)

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HL7 BAR Message HL7 BAR Message SemanticsSemantics ADT Actor generates the message whenever a patient is:

– Admitted– Pre-admitted– Registered

P01 event used to add a new account P05 (update account) event used to update an existing

account P06 (end account) event used to close an account

Optional One or more DG1 segments - Patient’s Diagnosis One or more GT1 segments – Guarantor Information One or more IN1 segments - Insurance Information

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Message SegmentMessage SegmentP01 - New AccountP01 - New Account

BAR Segment Billing Account Chapter in HL7 2.3.1

MSH Message Header 2

EVN Event Type 3

PID Patient Identification 3

[{DG1}] Diagnosis 6

[{GT1}] Guarantor 6

[{IN1}] Insurance 6

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Message SegmentMessage SegmentP05- Update AccountP05- Update Account

BAR Segment Billing Account Chapter in HL7 2.3.1

MSH Message Header 2

EVN Event Type 3

PID Patient Identification 3

[{DG1}] Diagnosis 6

[{GT1}] Guarantor 6

[{IN1}] Insurance 6

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Message SegmentMessage SegmentP06 - End AccountP06 - End Account

BAR Segment

Billing Account Chapter in HL7 2.3.1

MSH Message Header 2

EVN Event Type 3

PID Patient Identification 3

HIMSS/RSNA HIMSS 2003

Charge Posting Integration Profile

Questions?