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Transcript of September 24, 2014
electronic Submission of Medical Documentation (esMD)
electronic Determination of Coverage (eDoC) Workgroup
Oxygen Concentrators and Portable Oxygen (OCPO)
User Story LaunchSeptember 24, 2014
Sponsors & Support
2
PAMELA DURBIN, RN, BSN,CDS, ISSO
Health Insurance Specialist, COR II
CMS / OFM / Provider Compliance Group
DAN KALWA
Health Insurance Specialist,
CMS / OESS
MICHAEL HANDRIGAN, MD
Medical Officer
CMS / OFM / Provider Compliance Group
ROBERT DIETERLE,
Initiative Coordinator
MARK D PILLEY, MD AAFP, AADEP,
ABQAURP
Medical Director
Strategic Health Solutions, LLC
VIET NGUYEN, MD
Chief Medical Information Officer
Systems Made Simple, Inc.
SWETA LADWA, MPH
Project Manager / Epidemiology
ESAC, Inc.
Agenda / Presenter Opening Remarks
S&I Process
Overview of eDoC Workgroup
Related Initiatives
Description of Oxygen User Story
Structured Data
Mapping Oxygen to eDoC and Other Initiatives
Timeline and Summary
Closing Remarks
3
ROBERT DIETERLE
MARK PILLEY, MD
ROBERT DIETERLE
SWETA LADWA, MPH
“…a collaborative community of participants from the public and private
sectors who are focused on providing the tools, services and guidance to facilitate the functional exchange of health information.”
http://siframework.org/whatis.html
Standards & Interoperability (S&I) Framework
Why use the S&I Framework?
It is a robust, repeatable process that will help improve interoperability and adoption of standards and health information technology.
Solution Development Lifecycle
Use Case
• Create Use Case and User Stories• Actors and roles• Activity and Sequence diagrams• Dataset Requirements• Risks, Issues and obstacles• Sub-workgroup effort
• Structured data requirements• Templates for data capture• Decision support
Standards Harmonization
• Identify candidate standards• Create data model(s)• Map data model(s) to candidate standard(s)• Identify gaps, barriers and obstacles• Work with SDOs to address gaps
Implementation Guidance &
Piloting
• Create implementation guide(s) • Identify pilot participants• Develop pilot / demonstration plan• Evaluate success• Modify Implementation guide(s) as
required
Charter• Challenge statement• Timelines and milestones• Goals and outcomes
eDoC Phase Details
5
Related S&I Framework Initiatives
Initiative Description Relationship
Transitions of Care (C-CDA)
Defines the electronic communication and data elements necessary for clinical information exchange to support transfers of care between providers and between providers and patients
Standards for the exchange of clinical information
Provider Directories
Defines transaction requirements and core data sets needed to support queries to provider directories to enable electronic health information exchange
Electronic endpoints for participants in eDoC
Structured Data Capture (SDC)
External template driven capture of structured data within the EHR
Templates and workflow to capture payer required information
Health decisions (HeD)
Decision Support to enable complex workflows based on externally provided rules that enable capture of information and provide guidance for physician ordering
Decision support for data capture and preferred order management
esMD Author of Record
Standards for providing digital signatures to transactions and documentation.
Standards for Digital Signatures on transaction and documents
Direct a simple, secure, scalable, standards-based way for participants to send authenticated, encrypted health information
Utilize Direct as a transport mechanism between providers, payers and suppliers
Data Provenance (DPROV)
Standards for the provenance of medical record information that is exchanged for clinical or administrative purposes
Provides more detailed information regarding the origin and assembly of data elements in an electronic exchange
6
eDoC Workgroup Structure
Sub-WorkgroupsUser Stories
• Power Mobility Devices
• Lower Limb Prostheses
• Home Health Services
• Oxygen Concentrators and Portable Oxygen
Structured Data• Determine documentation
requirements• Evaluate appropriate
clinical elements• Clinical Vocabularies• Define CCDA template
Documentation Templates
• Define template requirements
• Define template workflow• Define EHR data capture
requirements• Specify storage
requirements
Transport
• ASC X12 275, 278, 277• CONNECT• Direct
eDoC Workgroup
Charter Use Case Harmonization Pilots
Consolidated CDA Structured Data Capture esMD eDoC IGs
7
esMD Background
Phase I of esMD was implemented in September of 2011. It enabled Providers to send Medical Documentation electronically
Review Contractor
Provider
Request Letter
Paper Medical Record
Phase 1: Doc’n
Request Letter
electronic
electronic
electronicPhase 2:
Before esMD: Healthcare payers frequently request that providers submit additional medical documentation to support a specific claim(s). Until recently, this has been an entirely paper process and has proven to be burdensome due to the time, resources, and cost to support a paper system.
The ONC S&I Framework Electronic Submission of Medical Documentation (esMD) initiative is developing solutions to support an entirely electronic documentation request.
8
esMD Process Flow
The overall esMD process can be divided into three steps:
• A provider registers with a payer to receive electronic medical documentation requests (eMDRs)
1. Register to Receive eMDRs
• A payer sends an eMDR to a registered provider
2. Send eMDRs• A provider
electronically sends medical documentation to a payer in response to an eMDR
3. Send Medical Documentation
esMD Phase 2 esMD Phase 1
9
Underlying Challenge:
• Enable provider capture of documentation and benefit determination based on payer rules
• Secure exchange of templates, decision support, and documentation between payers, providers, service suppliers and beneficiary
Scope:• Focus on defining the use case, user stories and requirements supporting a standards-
based architecture• Reuse of existing S&I Initiative efforts where possible• Creation of structured data capture templates and supporting exchange standards• General approach to documentation as the Use Case• Specific benefits as user stories (Oxygen Concentrators and Portable Oxygen (OCPO)
Outcome:
• Successful pilot of templates, decision support, information exchange standards over standard secure transactions for the purpose of determining coverage
• Validation of user story for Oxygen Concentrators and Portable Oxygen (OCPO)
Electronic Determination of Coverage (eDoC)
10
eDoC General Workflow
Payer
Patient
LCMP / IDTFSpecialist /Service Provider
Physician
Templates and Rules
11
Oxygen Concentrator / Portable Oxygen (OCPO)Oxygen Concentrator / Portable Oxygen (OCPO)
12
Improper Payment - OCPO Highest Medicare Improper Payment for Service Types
Billed to DME – Oxygen Supplies/Equipment
$1.2 Billion – 75.2% (CERT Improper Payments, 2013)
No Documentation – 0.3%
Insufficient Documentation Errors – 73.2%
Oxygen Concentrators (E1390) - $1 Billion – 75.6% Overpayment Rate
Claims Containing Errors – 68.1%
(Medicare FFS 2013 Improper Payment Rate Report – Supplementary Appendices )
2006 Office of Inspector General (OIG) Report
“Medicare Home Oxygen Equipment: Cost and Servicing”
• 2004 – Home Oxygen Equipment
• 24% of all Medicare DME, Prosthetics, Orthotics and Supplies (DMEPOS) Costs
• $2.7 Billion of $11.1 Billion total payments for DMEPOS
Service Type Improper Payment
Rate
Improper Payment
Amount
Inpatient Hospitals 8.0% $9.4B
Durable Medical
Equipment 58.2% $5.7B
Physician/Lab/Ambulance 10.5% $9.5B
Non-Inpatient Hospital
Facilities 8.2% $11.4B
Overall 10.1% $36.0B
OCPO Definition
OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT, CAPABLE OF DELIVERING 85 PERCENT OR GREATER OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW RATE
E1390
OXYGEN CONCENTRATOR, DUAL DELIVERY PORT, CAPABLE OF DELIVERING 85 PERCENT OR GREATER OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW RATE, EACH
E1391
PORTABLE OXYGEN CONCENTRATOR, RENTAL E1392
PORTABLE GASEOUS OXYGEN SYSTEM, RENTAL; HOME COMPRESSOR USED TO FILL PORTABLE OXYGEN CYLINDERS; INCLUDES PORTABLE CONTAINERS, REGULATOR, FLOWMETER, HUMIDIFIER, CANNULA ORMASK, AND TUBING
K0738
14
OCPO Reviews require Suppliers to submit:– Evidence of qualifying test results
• Performed within 30 days before initial date of service (DOS)
– Evidence of in-person visit with a treating physician• Performed within 30 days before initial date of service (DOS)
– Detailed written order
– NCD – Home Use of Oxygen (240.2)• Coverage requires patient testing when in the “Chronic Stable State”• All Co-Existing “Diseases or Conditions that can cause hypoxia must be treated
sufficiently.” • Patient “Must have a severe lung disease”:e.g.;
– “COPD, diffuse interstitial lung disease, cystic fibrosis, bronchiectasis, widespread pulmonary neoplasm, or hypoxia-related symptoms or findings anticipated to be improved with Oxygen Therapy.”
OCPO Reviews
15
OCPO Reviews require Suppliers to submit:– Certificate of Medical Necessity (CMN)
• Completed, signed, and dated by the treating physician• May act as a substitute for detailed written order• CMS Form 484 (DME form 484.03)
– Proof of Delivery
– Any other medical documentation to support the LCD requirements
OCPO Reviews
16
OCPO – Detailed Written Order (DWO)
• Detailed Written Order
– The detailed written order must include: – Patient name; – Detailed description of the items being provided, including:
a. The means of oxygen delivery,
b. The specifics of varying oxygen flow rates and/or non-continuous use of oxygen, and
c. The length of need; – Treating physician’s signature and date order signed; and – Start date of the order (only required if the start date is different from the signature
date)– .
OCPO – Order Requirements
17
OCPO DefinitionPORTABLE GASEOUS OXYGEN SYSTEM, RENTAL; INCLUDES PORTABLE CONTAINER, REGULATOR, FLOWMETER, HUMIDIFIER, CANNULA OR MASK, AND TUBING
E0431
PORTABLE LIQUID OXYGEN SYSTEM, RENTAL; HOME LIQUEFIER USED TO FILL PORTABLE LIQUID OXYGEN CONTAINERS, INCLUDES PORTABLE CONTAINERS, REGULATOR, FLOWMETER, HUMIDIFIER, CANNULA OR MASK AND TUBING, WITH OR WITHOUT SUPPLY RESERVOIR AND CONTENTS GAUGE
E0433
PORTABLE LIQUID OXYGEN SYSTEM, RENTAL; INCLUDES PORTABLE CONTAINER, SUPPLY RESERVOIR, HUMIDIFIER, FLOWMETER, REFILL ADAPTOR, CONTENTS GAUGE, CANNULA OR MASK, AND TUBING
E0434
• Requires an in-person or face-to-face interaction prior to prescribing• A Written Order Prior to Delivery (WOPD) – required• DMEPOS supplier must have documentation of:
• face-to-face visit, &• completed WOPD prior to the delivery• must be sufficient information documented meeting applicable
coverage criteria are met.
AFFORDABLE CARE ACT (ACA) 6407 REQUIREMENTS
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OCPO Documentation submission methods
– Mail – USPS, FedEx, UPS
– Fax – to secured site
– CD/DVD - Password Protected
– esMD – via HIH
OCPO Submission Methods
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• Order Validation – New
• Prepay Review - Ongoing
• Post-pay Review - Ongoing
Types of Review
20
Visits Physician/ Practitioner – Opt Office / EDHospitalized for Respiratory Failure / Exacerbation of COPD / Pneumonia, etc. – Medical Documentation substantiates Requires &/or Benefits from Supplemental O2B
en
efi
cia
ry
Ord
eri
ng
P
hysic
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/Pra
cti
tio
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Su
pp
lier
Documents the in person visit or F2F visit in Medical Documentation, (progress note, medical record, Hospital H&P/Dismissal Summary/Transfer Sheet ) Must include: - Diagnosis supporting need for OCPO, Exam findings, Required
Testing
Writes, signs, and dates DWO andCompletes the CMN
Completes OCPO Delivery
IDTF/Hosp/HomeOrders ABGs, Oximetry, 6-minute walk, PFTs, VO2 Max, etc.Refers for Sleep Study
Obtains Proof of Delivery (POD)
Receives/Files F2F visit progress note, DWO, and CMN
Submits Documentation Package including:• In person visit or F2F visit• DWO• CMN• POD• Other Supporting Documentation
Request Process for OCPO
21
Visits Physician/ Practitioner – Opt Office / EDHospitalized for Respiratory Failure / Exacerbation of COPD / Pneumonia, etc. – Medical Documentation substantiates Requires &/or Benefits from Supplemental O2B
en
efi
cia
ry
Ord
eri
ng
P
hysic
ian
/Pra
cti
tio
ner
Su
pp
lier
Documents the in person visit or F2F visit in Medical Documentation, (progress note, medical record, Hospital H&P/Dismissal Summary/Transfer Sheet ) Must include: - Diagnosis supporting need for OCPO, Exam findings, Required
Testing
Writes, signs, and dates DWO andCompletes the CMN
Completes OCPO Delivery
IDTF/Hosp/HomeOrders ABGs, Oximetry, 6-minute walk, PFTs, VO2 Max, etc.Refers for Sleep Study
Obtains Proof of Delivery (POD)
Receives/Files F2F visit progress note, DWO, and CMN
Submits Documentation Package including:• In person visit or F2F visit• DWO• CMN POD• Other Supporting Documentation
Request Process for OCPO - Order Validation
22
DWO – Order Validation
eDoC General Workflow
Payer
Patient
DME SupplierPhysician
Templates and Rules
23
IDTF / Hosp / Opt Lab
OCPO Documentation & Coverage Requirements
Common Oxygen and Oxygen Equipment Errors MLN ICN 904883 December 2011
1. Missing documentation showing that the patient was seen by a physician within the appropriate timeframes for certification or recertification of the need for oxygen supplies.
2. Missing documentation of original blood gas or saturation test results.
3. Missing documentation indicating that the patient needs or is using oxygen and supplies.
4. Missing documentation to show that the patient is mobile within the home (for portable oxygen).
5. Missing physician order for oxygen supplies.
6. Missing the most recent Certificate of Medical Necessity (CMN).
OCPO Documentation & Coverage Requirements
Overlooked Policy Requirements MLN ICN 904883 December 2011
1. Medicare requires home oxygen to be ordered by a physician after evaluating a patient’s medical need. This visit must occur either prior to, but no earlier than, 2 days prior to the inpatient hospital discharge date, or while the patient is in a chronic stable state. The physician notes must establish the need for oxygen based upon Local Coverage Determination (LCD) requirements and show that the visit (and test) does not exceed 30 days from the Initial Date on the CMN.
2. For Medicare to pay for oxygen equipment, a patient must have both a continued need for oxygen in the home and must also be using the equipment.
3. For patients to qualify for portable oxygen, they must be mobile within the home and be tested under specific conditions (during exercise or at rest).
4. Medicare requires all patients who use home oxygen to first be tested either by arterial blood gas (ABG) or oximetry test (SAT). There must be a record of the test results in the physician’s notes to verify that the test occurred.
OCPO Documentation & Coverage Requirements
Oxygen Documentation Checklist
Medicare requires the following documentation for Medicare oxygen therapy:MLN ICN 904883 December 2011
Detailed Written Order
The detailed written order must include: • Patient name; • Detailed description of the items being provided, including:
– a. The means of oxygen delivery, – b. The specifics of varying oxygen flow rates and/or non-continuous use of
oxygen, and – c. The length of need;
• Treating physician’s signature and date order signed; and • Start date of the order (only required if the start date is different from the signature
date)
OCPO Documentation & Coverage Requirements
Oxygen Documentation Checklist
Medicare requires the following documentation for Medicare oxygen therapy: MLN ICN 904883 December 2011
Coverage – Home oxygen therapy is covered only if all of the following conditions are met:– The treating physician has determined that the patient has a severe lung disease or hypoxia-related
symptoms that might be expected to improve with oxygen therapy. – The patient’s blood gas study meets the criteria stated below.
• The qualifying blood gas study was performed by a physician or by a qualified provider or supplier of laboratory services.
• The qualifying blood gas study was obtained under the following conditions (a or b): – a. If the qualifying blood gas study is performed during an inpatient hospital stay, the
reported test must be the one obtained closest to, but no earlier than, 2 days prior to the hospital discharge date; or
– b. If the qualifying blood gas study is not performed during an inpatient hospital stay, the reported test must be performed while the patient is in a chronic stable state (that is, not during a period of acute illness or an exacerbation of his or her underlying disease).
• Alternative treatment measures have been tried or considered and deemed clinically ineffective.
OCPO Documentation & Coverage Requirements
Oxygen Documentation Checklist
Medicare requires the following documentation for Medicare oxygen therapy: MLN ICN 904883 December 2011
Medicare Qualifying Saturation Test Results – Medicare covers home oxygen therapy only if the patient’s arterial saturation
test results meet the following criteria: – The patient’s test results must be within 48 hours of the date of delivery,
unless the arterial saturation tests were taken during an outpatient encounter or during the patient’s sleep. If tests were taken during an outpatient encounter or during the patient’s sleep, the patient’s arterial saturation test results must be within 30 days of the date of delivery.
– Arterial saturation test results that qualify for coverage are classified into Group I or Group II. The group determines specific CMN requirements. The criteria for each group are listed in Table 1 and Table 2 below. (Following Slides)
Structured Information for OCPO
• Supports• Data collection by providers during in person visit or face-
to-face visit• Reporting of clinical information for coverage
determination• Clinical decision support and automated determination of
coverage
29
Evaluation Process for OCPO Structured Documentation
• Examination of individual clinical elements for each section of the template
• Determine if a clinical element is codifiable (e.g. Diagnosis), requires a narrative (e.g. History of Present Illness), or is mixed (e.g. Review of Systems)
• Compare coded elements to existing standard coding systems (e.g. SNOMED-CT, ICD) and CDA components
• Map to CDP1 Template Sections and Entries based on User Story Requirements
30
References/Contact Information
LinksesMD Initiative: http://wiki.siframework.org/esMD+Initiative
esMD Program: http://www.cms.gov/esmdesMD eDoC Initiative:
http://wiki.siframework.org/esMD+- +Electronic+Determination+of+Coverage
Contact InformationRobert Dieterle – esMD Initiative Coordinator ([email protected])
Sweta Ladwa – ESAC ([email protected] )
Dan Kalwa – CMS ([email protected])
Pamela Durbin – CMS ([email protected])
Dr Mark Pilley – Co Lead ([email protected])
Dr. Viet Nguyen – Co Lead ([email protected]
31
References for Coverage and Documentation Requirements
• Complete coverage and documentation requirements are outlined in the following policy and CMS Publication:
National Coverage Determination (NCD) for OCPOhttp://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=169&ncdver=1&DocID=240.2&SearchType=Advanced&bc=IAAAABAAAAAA&
CMS MLN Matters - https://www.cms.gov/Outreach-and Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM4389.pdf• Provides further guidance and clarification about
documentation for physicians and treating practitioners when ordering OCPO
32
References for Coverage and Documentation Requirements
• Additional Guidance regarding coverage and documentation requirements are outlined in the following CMS Transmittals:
The NCD can be found in transmittal 57, CR4389, athttp://www.cms.gov.Regulations-and-Guidance/Guidance/Transmittals/downloads/R57NCD.pdf
on the CMS website
Claims processing instructions are available in Transmittal 961, CR4389, which is available at http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads?R961CP.pdf on the CMS website
33
References for Coverage and Documentation Requirements
• Additional Guidance regarding coverage and documentation requirements for Home Oxygen Use for Cluster Headache (CH) are outlined in the following CMS Transmittals:
Assigned Codes for Home Oxygen Use for Cluster Headache (CH) in a Clinical Trial (ICD-10) – MM7820 – Transmittal #: R2465CP
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM7820.pdf
The official instruction, CR7820, is located at http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2465CP.pdf on the CMS website
34
References for Coverage and Documentation Requirements
• DME MAC policy regarding coverage and documentation requirements are outlined in the following policies:
• LCDs and LCD Articles for OCPOJurisdiction A LCDJurisdiction B LCDJurisdiction C LCD Jurisdiction D LCD
http://www.cms.gov/medicare-coverage-database/search/search- results.aspx?SearchType=Advanced&CoverageSelection=Local&ArticleType=SAD%7cEd&PolicyType=Both&s=All&CntrctrType=10&KeyWord=Oxygen+and+Oxygen+Equipment&KeyWordLookUp=Title&KeyWordSearchType=Exact&kq=true&bc=IAAAAAAAAAAAAA%3d%3d&
35
References for Coverage and Documentation Requirements
• DME MAC policy regarding coverage and documentation requirements are outlined in the following policies:
• LCDs Oxygen and Oxygen Equipment (OCPO)Jurisdiction A LCDhttp://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=11468&ContrId=137&ver=69&ContrVer=1&SearchType=Advanced&CoverageSelection=Local&ArticleType=SAD%7cEd&PolicyType=Both&s=All&CntrctrType=10&KeyWord=Oxygen+and+Oxygen+Equipment&KeyWordLookUp=Title&KeyWordSearchType=Exact&kq=true&bc=IAAAABAAAAAAAA%3d%3d&
Jurisdiction B LCDhttp://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=27221&ContrId=138&ver=44&ContrVer=1&SearchType=Advanced&CoverageSelection=Local&ArticleType=SAD%7cEd&PolicyType=Both&s=All&CntrctrType=10&KeyWord=Oxygen+and+Oxygen+Equipment&KeyWordLookUp=Title&KeyWordSearchType=Exact&kq=true&bc=IAAAABAAAAAAAA%3d%3d&
Jurisdiction C LCD
http://www.cms.gov/medicare-coverage-database/shared/handlers/highwire.ashx?url=http://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx@@@LCDId$$$11446***ContrId$$$140***ver$$$75***ContrVer$$$2***SearchType$$$Advanced***CoverageSelection$$$Local***ArticleType$$$SAD|Ed***PolicyType$$$Both***s$$$All***CntrctrType$$$10***KeyWord$$$Oxygen+and+Oxygen+Equipment***KeyWordLookUp$$$Title***KeyWordSearchType$$$Exact***kq$$$true***bc$$$IAAAABAAAAAAAA$$$$$$***&session=phelks45atn2ebmyr5z3ot55&
kq=876734436
Jurisdiction D LCD http://www.cms.gov/medicare-coverage-database/shared/handlers/highwire.ashx?url=http://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx@@@LCDId$$$11457***ContrId$$$139***ver$$$72***ContrVer$$$2***SearchType$$$Advanced***CoverageSelection$$$Local***ArticleType$$$SAD|Ed***PolicyType$$$Both***s$$$All***CntrctrType$$$10***KeyWord$$$Oxygen+and+Oxygen+Equipment***KeyWordLookUp$$$Title***KeyWordSearchType$$$Exact***kq$$$true***bc$$$IAAAABAAAAAAAA$$$$$$***&session=phelks45atn2ebmyr5z3ot55&kq=1789128138
36
References on OCPOs from the DME MACs
• Jurisdiction A: NHIC, Corp.
• http://www.medicarenhic.com/dme
• Jurisdiction B: National Government Services (NGS)
• http://www.ngsmedicare.com/wps/portal/ngsmedicare/home
• Juridiction C: CGS
• http://www.cgsmedicare.com/jc
• Jurisdiction D:Noridian Administrative Services, LLC (NAS)
• https://www.noridianmedicare.com/dme
37
Sub Workgroup LLP Structured Data
OCPO – User Story Development
OCPO Pilots
Kick-Off
Oct ‘14 Dec ‘ 14 Feb ‘15Sept ‘14 Nov ‘14 Jan ‘15 Mar‘15
Standards/Data Model/Harmonization
eDoC OCPO Timeline
38
OCPOImplementation
Guide
Apr ‘15
eDoC Timeline
February ‘14October ‘13 December ‘13
eDoC Harmonization and Structured Data
April ‘14 June ‘14 August ‘14 October ‘14 December ‘14 February ‘15
PMD and LLP e-Clinical Template Pilots
LLP User Story
eDoC Administrative Documents Templates IG for HL7 Ballot
We are here
Electronic Determination of Coverage WG
Home Health User Story
eDoC HL7 Clinical Documents for Payers Set 1 Ballot Reconciliation
Oxygen Concentrators and Portable Oxygen User Story
Call for Public ParticipationAs an S&I Initiative, esMD is requesting public participation and input to identify and assess existing standards and define requirements for the eDoC OCPO User Story
• Targeted Participants:• Medicare, Medicaid, and Commercial Payers• Providers, Provider Organizations • Service suppliers (e.g. DMEs)• Health Information Handlers (HIHs)• HIT/EHR Vendors and Vendor Associations• State HIEs, HIE Vendors• SDOs• Others with Expertise/Interest in Coverage Determination, Structured
Documentation, Decision Support, and Pre-authorization,
40
Summary
eDoC workgroup identifies Best Practice for:1) Payer interaction with providers for determination of coverage
2) Developing, delivering and using structured information to support coverage determination
3) Addressing Author of Record requirements
4) Establishing secure electronic communication between payers, provider, suppliers and beneficiaries
5) Creating implementation guides for payers and providers for all required eDoC processes and transactions
The focus for next user story is on Oxygen Concentrators and Portable Oxygen (OCPO)
41
Next Steps• The electronic Determination of Coverage Workgroup is open for anyone
to join. This community will meet weekly by webinar and teleconference from 1:00 to 2:00 pm ET on Wednesday see S&I Framework calendar for webinar information: http://wiki.siframework.org/Calendar
• Information on how to join the esMD Community can be found on the electronic submission of Medical Documentation (esMD) page: http://wiki.siframework.org/esMD+Initiative
• In order to ensure the success of the eDoC efforts, we encourage broad and diverse participation from the community. Wide community participation will ensure that the standards reflect technology that is useable across the industry and meets the needs of all stakeholders.
• This is your chance to have an impact on the evaluation and selection of standards, in addition to the creation of business requirements and implementation guides for the electronic Determination of Coverage OCPO User Story
42
Thank You
44