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

2. HIMSS/RSNAHIMSS 2003 Integration Profiles Scheduled 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 Charge Posting Collect and post timely billable procedure details triggers

3. HIMSS/RSNAHIMSS 2003 OBJECTIVES Standardize the Charge Posted Transaction to the Charge Processor Reduce System Interface Installation Time – Between Clinical Systems and the Charge Processors Reduce the Need of the Billing System to Have Knowledge of the Radiology Internals.

4. HIMSS/RSNAHIMSS 2003 RESULT Charge Processor will receive more complete, timely and accurate data.

5. HIMSS/RSNAHIMSS 2003 Types 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

6. HIMSS/RSNAHIMSS 2003 Express 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.

7. HIMSS/RSNAHIMSS 2003 To 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

8. HIMSS/RSNAHIMSS 2003 Real-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

9. HIMSS/RSNAHIMSS 2003 Transaction Diagram

10. HIMSS/RSNAHIMSS 2003 Charge Posted Transaction Department System Scheduler/Order Filler sends descriptions of performed procedure(s) and material changes

11. HIMSS/RSNAHIMSS 2003 Workflow 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

12. HIMSS/RSNAHIMSS 2003 Scope 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.

13. HIMSS/RSNAHIMSS 2003 Data 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

14. HIMSS/RSNAHIMSS 2003 New Concept Chargeable Procedure Procedure that generates a charge to be applied to a patients account Corresponding charge information is sent to the Charge Processor Managed by the Department System Scheduler/Order Filler to ensure it is accurate.

15. HIMSS/RSNAHIMSS 2003 Use Case Roles 1. Department System Scheduler / Order Filler 2. Charge Processor

16. HIMSS/RSNAHIMSS 2003 Use 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

17. HIMSS/RSNAHIMSS 2003 Actor: Department System Scheduler /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

18. HIMSS/RSNAHIMSS 2003 Actor: Charge 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.

19. HIMSS/RSNAHIMSS 2003 Interaction Diagram

20. HIMSS/RSNAHIMSS 2003 Trigger Events Procedure Ordered Procedure Scheduled Procedure Completed Result Dictated Result Transcribed Result Verified Note: Events can be different for technical and professional charges.

21. HIMSS/RSNAHIMSS 2003 Detailed Financial Transaction 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.

22. HIMSS/RSNAHIMSS 2003 HL7 DFT Message Semantics 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.

23. HIMSS/RSNAHIMSS 2003 Message Segments DFT SegmentDetailed Financial Transaction Message Chapter in HL7 2.3.1 MSHMessage Header2 EVNEvent Type3 PIDPatient Identification3 {FT1}Financial Transaction6 [{PR1}]Procedure6

24. HIMSS/RSNAHIMSS 2003 Account Management Transaction – 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

25. HIMSS/RSNAHIMSS 2003 Use Case Roles 1. ADT Patient Registration 2. Charge Processor

26. HIMSS/RSNAHIMSS 2003 Actor: ADT Patient Registration Collects information relevant to the patient account and submits it to the Charge Processor

27. HIMSS/RSNAHIMSS 2003 Actor: Charge Processor Receives the information from Patient Registration Processes and combines charges Issues an insurance claim or patients billing statement.

28. HIMSS/RSNAHIMSS 2003 Interaction Diagram

29. HIMSS/RSNAHIMSS 2003 Trigger 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)

30. HIMSS/RSNAHIMSS 2003 HL7 BAR Message Semantics 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 - Patients Diagnosis One or more GT1 segments – Guarantor Information One or more IN1 segments - Insurance Information

31. HIMSS/RSNAHIMSS 2003 Message Segment P01 - New Account BAR SegmentBilling AccountChapter in HL7 2.3.1 MSHMessage Header2 EVNEvent Type3 PIDPatient Identification3 [{DG1}]Diagnosis6 [{GT1}]Guarantor6 [{IN1}]Insurance6

32. HIMSS/RSNAHIMSS 2003 Message Segment P05- Update Account BAR SegmentBilling AccountChapter in HL7 2.3.1 MSHMessage Header2 EVNEvent Type3 PIDPatient Identification3 [{DG1}]Diagnosis6 [{GT1}]Guarantor6 [{IN1}]Insurance6

33. HIMSS/RSNAHIMSS 2003 Message Segment P06 - End Account BAR Segment Billing AccountChapter in HL7 2.3.1 MSHMessage Header2 EVNEvent Type3 PIDPatient Identification3

34. HIMSS/RSNAHIMSS 2003 Charge Posting Integration Profile Questions?