2021-09-17 Patient Cost Transparency Meeting
Transcript of 2021-09-17 Patient Cost Transparency Meeting
2021-09-17 Patient Cost Transparency Meeting
Chair: , Viet Nguyen Vanessa Candelora
Scribe: Phung Matthews
Minutes Approved as Presented
Agenda Topics
(reminder to record)
Agenda Outline
Agenda Item Meeting Minutes from Discussion Decision Link(if not child)
Management
Review ANSI Anti-Trust Policy
Housekeeping
HL7 Work Group Meetings
Sept 20-24, 2021
35th Annual Plenary & Working Group Meeting (Eastern Time)
Network, learn and influence interoperability!Virtual Event
Learn More and Register here: https://www.hl7.org/events/working_group_meeting/2021/09/
Call is cancelled for next week.
Sept 2021 WGM - Da Vinci Discussions - See here for all the places Da Vinci will be.
Today Recording 9/17/2021
Project Update Creating FHIR IG Proposal - HL7 milestone is Sept. 24th.
We are looking for expected implementations, please drop a note in the chat or let Vanessa ( vanessa.candelora@pocp. ) or know if you are interested in being listed. com Viet Nguyen
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."
X12 Comments on the No Surprises Act Interim Final Rule
https://x12.org/news-and-events/news/x12-comments-no-surprises-act-interim-final-rule
Slide deck for today
Chat comments 11:06 AMMe to Everyone
https://confluence.hl7.org/display/DVP/2021-09-17+Patient+Cost+Transparency+Meeting - Notes for today with links to deck.
11:21 AM to EveryoneLinda Michaelsen
how would payer know when it is done?
11:23 AM to EveryoneEric Ellsworth (Consumers' Checkbook)
What if one of the providers provides info that changes another provider's estimate?E.g. anesthesiologist gives the patient a worse ASA score than the surgeon expected
11:25 AM to EveryoneTeddy Rhoads
Are there any thoughts around cooridation of a secondary payer '2 insurance coverages for a member' or is that out of scope?
11:27 AM to EveryoneSam Undine (BCBSA)
Will the scenarios be presented at a later meeting for feedback after folks have had a chance to digest?
11:31 AM to EveryoneCat Douglas (Florida Blue)
Yes - storage in document repositories for members to access completed AEOBs for a period of time. No to sending back AEOBs to the providers. For GFE, storing the data in the request/response. Both to be future used to audit compliance as well as future state compare the differences between the AEOB and then the post service claim.
11:35 AM to EveryoneViet Nguyen
How does the remit play into the AEOB. The remit is specific and post-service and post-claim, right?
11:38 AM to EveryoneViet Nguyen
Participants - Is question 1 now answered sufficiently? What follow-on questions do we have from Question 1? Please enter here in chat.
11:40 AM to EveryoneEric Ellsworth (Consumers' Checkbook)
Given the likelihood of change leading up to procedures, I'd think an approach that having a static machine-readable "thing" that represents the current state of the AEOB (i.e. more than just a document) in the run-up to the procedure
11:41 AM to EveryoneEric Ellsworth (Consumers' Checkbook)
For a surgery involving anesthesiology, does the cardiologist get access?
11:42 AM to EveryoneCait O'Donnell - Smile CDR
Third party?
11:51 AM to EveryoneViet Nguyen
The providers submitting the AEOBs would need to be able to identify themselves both administratively (NPI/TIN) as well as technically (FHIR)
11:51 AM to EveryoneSam Undine (BCBSA)
Bob, could you share more about that in chat?
11:52 AM to EveryoneBryan Briegel (IBM Watson Health)
the caa provider directory statute requires digital endpoints -
11:52 AM to EveryoneSam Undine (BCBSA)
What's the new element being discussed for Plan Net?
11:52 AM to EveryoneSam Undine (BCBSA)
Bryan, thanks. Do they give more detail on what that entails? Is it email, website, something else?
11:53 AM to EveryoneFrank Opelka
The intent is NOT transaction by transaction reporting back to the billing source. It is to provide a summary of the total cost of care (of all services) so that action can be taken to reduce unwarranted services.
11:53 AM to EveryoneEric Ellsworth (Consumers' Checkbook)
Has there been any workflows developed on the patient's potential actions after receiving an AEOB or GFE?
11:54 AM to EveryoneFrank Opelka
Individuals already know their contracted rates - what they do not know is the number of services provided in an episode of care.
11:54 AM to EveryoneFrank Opelka
Viet, the idea of a pull is excellent.
11:55 AM to EveryoneEric Ellsworth (Consumers' Checkbook)
My guess is that for a good period of time patients are going to have sticker shock
11:55 AM to EveryoneFrank Opelka
The pull should be parse-able to allow for business intelligence at the site of care.
11:55 AM to EveryoneStanley Nachimson
We should be looking to duplicate the current patient EOB process.
11:55 AM to EveryoneRobert Dieterle (EnableCare)
No new elements -- endpoint is part of the current Plan Net and the FAST national directory work
Next Share on Inquiry to Payer for the AEOB (which includes the GFE).
Best method for the Payer to Provider AEOB - Push or subscribe, Provider endpoint.
Management
Next Agenda Cancel for HL7 WGM on 9/24. Next Meeting is 10/1.
Adjournment
Adjourned at 11:55am ET
Supporting Documents
Outline Reference Supporting Document
Minute Approval
Meeting Presentation Materials CARIN IG For BB Technical Overview 09032021.pdf
Supporting Information Links Patient Cost Transparency Supporting Materials
Da Vinci PCT GlossaryDa Vinci Steering Committee PCT Scope StatementPatient Cost Transparency FAQsPCT Discovery and Requirements - Example ScenariosPCT Project TrackingPCT Requirements Gathering
GFE Data Element List v4.xlsx
Recording Recording 9/17/2021
Action items
Alice - very important to follow-up with question to CMS: how will the provider do the coordination with other providers in 24hours to get the GFE pulled together?
Type your task here, using "@" to assign to a user and "//" to select a due date
Attendees - 64
Present Name Affiliation
Viet Nguyen Stratametrics
Jocelyn Keegan POCP
Vanessa Candelora POCP
Larry Decelles MITRE
Gary P. Gryan MITRE
Joseph Minieri MITRE
Jeff Brown MITRE
Tab Harris FL Blue
Alice O'Carroll FL Blue
Caitlyn Campi FL Blue
Kelly Springmann FL Blue
Cat Douglas FL Blue
Cecilia Funk Optum
Marci Maisano Cigna
Megan Soccorso Cigna
Phung Matthews POCP
Nita K. Thingalaya IBC
Heather Kennedy BCBS TN
Frank Opelka PACES Center
Richard Bloch Providence St. Joseph
Ben Teisman EPIC
Saul Kravitz MITRE
Robert Dieterle Enablecare
Jim StClair Lumedic (Providence St. Joseph)
Lorraine Doo CMS
Luke Rockenbach Providence St. Joseph
Mariel Brechner Evernorth
Kevin Larsen Optum
Patricia Taylor BCBSA
Jacob Woodford EPIC
Teresa McSpadden Providence St. Joseph
Tim McNeil Surescripts
David DeGandi Cambia
Shanna Hartman CMS
Alex Mugge CMS
Pat Waller Cambia
Michael Gould BCBSA
Linda Michaelsen Optum
Caryn Vaughn Providence Health plan
India Duncan Optum
Amanda Garlock Providence - Imaging
Seth Wainer Providence Health plan (Compliance)
Drew Bryan Providence Health Plan (Tech)
Mary Kay McDaniel Financial Mgmt Group at HL7
Rany El Diwany Athena Health
Tony Benson BCBS AL
Jill Vincente Weill Cornell Medicine
Jarrett Cox Weill Cornell Medicine
Bryan Kirk CCIIO (division of CMS)
Adam Garner HCA Healthcare
Brian Johnson HCA Healthcare
Rebecca Dooley HCA Healthcare
Scott Abram SutterHealth
@Lynn Chapple Optum, x12 Co-Chair for 837 IGs
Ali Ozden
Alvin Yu Optum
Amy Kelly Medical Mutual
Anthony Omosule
Ashley DePalma MVP Healthcare
Barbara Doyle BAH
Behara, Prasanthkumar
Beth Davis AllScripts
Brian Dwyer POCP
Bror Johnson retentionsearch
Cambridge, Joseph
Choudhury, Shafaq
Durwin Day BCBSIL
Eric Grindstaff AllScripts
Erin Weber CAQH
Hayer, Andy
Heather McComas AMA
James Macurak
Janice Karin MHDC
Jo Thompson Molina
Joe Quinn HSX
Jonathan Perry CMS
Keeli Kellene Strub
Kris Encino WebTPA
Mark Pencek Medical Mutual
Matt Schuller BCBSA
Melanie Combs-Dyer Mettle Solutions
Michelle Barry Availity
Mike Denison Change Healthcare
Michael Marchant UC Davis
Nikki Henck Ideal Care Solutions
Phranil Mehta Healow
Rachel E. Foerster Rachel Foerster & Associates, Ltd.
(RFA)
Shelly Kitchen
Sheryl Turney Anthem
Stanley Nachimson Nachimson Advisors LLC
Stephanie Raymond Tufts
Susan Gartzke
Susan Langford BCBS TN
Terrence Cunningham AHA
Thomson Kuhn
Cait O'Donnell Smile CDR
Bryan Briegel IBM Watson Health
Shawn Bryant WPS
Collin KreKlow WPS
Denise St Clair Acumen
Genie Cilliam Anthem
Jim Haley Arkansas Blue
Peter Liu Smile CDR
Mark Scrimshire OnyxHealth.io
Khalid Muqueeth Inovalon
Katie Leblanc PSJ
Jean Mitchell WPS
Nick Merrick
Sam Undine BCBSA
Tara Rose
Tom Mort Availity
Kim Turner WPS
Anil N
Bettina Vanover Cognizant
Danny iacovou
Samuel Benton
Serafina Versaggi
Diederik Muylwyk Smile CDR
Pooja POCP
Thomas Mort
Yolanda Liu MITRE
Jessica Czulewicz CMS
Kamashi Cognizant
Kirk Fahlberg
Debbie Stimmel
Aria Walker
Jon Woolf
Taha Anjarwalla
Christopher Gracon X12
Kimberly Bradbury
Caleb Wan MITRE
Nick Dahl Cognisant
Rennil Cruz
Eric Ellsworth
Suzanne Houlton
Kaitlin Powers CAQH
RAnjith Kandur Anthem
Jeff Helman
Hong Huang Cambia Health
Amol Vyas Cambia Health
Corey Spears MITRE
Nick Radov
Paul Knapp
Vik Sachdev
Seth Paradis
Casey Smith Providence
Bob Bowman
Attendees from today 9/17:
Amol Vyas (Cambia Health)
Aria Walker
Aria Walker
Barbara Doyle
Bettina Vanover
Bryan Briegel (IBM Watson Health)
Cait O'Donnell - Smile CDR
Caitlyn Campi
Caleb Wan (MITRE)
Caryn Vaughn
Casey Smith (Providence)
Cat Douglas (Florida Blue)
Celine Lefebvre
Clark, Marjorie
Collin Kreklow (WPS)
Corey Spears (MITRE)
Denise St Clair (Acumen)(she/her)
Drew Bryan (Providence)
Durwin Day
Erin Weber
Eric Ellsworth (Consumers' Checkbook)
Frank Opelka
Funk, Cecilia
Gary Gryan
Genie Gilliam (Anthem)
Hong Huang
Jacob Woodford (Epic)
Jean Mitchell (WPS)
Jeff Brown (MITRE) - HL7 FM Co-Chair
Jessica Czulewicz (CMS)
Joe Minieri
Julie Burgoon
Kaitlin Powers (CAQH CORE)
Kenny Wang
Kevin Larsen, MD Optum
Khalid Muqueeth (Inovalon)
Kimberly Bradbury
Larry Decelles (MITRE)
Laurie Warren
Leon Jang (Ability Network)
Linda Michaelsen
lorraine doo
Lynn Chapple
Mariel Brechner
Mark S( )onyxhealth.io
MaryKay McDaniel (Markam - HL7 FM CoChair)
Melanie Combs-Dyer (Mettle)
Michelle Barry
Nick Merrick
Nikki Henck, Smile CDR
Rachel Foerster
Ranjith Kandur (Anthem)
Rany El Diwany (athenaHealth)
Rennil Cruz
Robert Dieterle (EnableCare)
Rockenbach, Luke (Providence)
Sam Undine (BCBSA)
Scott Abram
Serafina Versaggi
Stanley Nachimson
Susan Langford
Taha Anjarwalla
Teddy Rhoads
Teresa - Providence
Tony Benson
User
Vanessa Candelora
Viet Nguyen
Vik Sachdev
Walsh, LaToya
Yolanda Liu