HL7 Financial Management Work Group Meeting Minutes 

	
May 2011, Orlando, FL	

. 

Monday
Structured Documents/Claim Attachments

HL7 Claim Attachments Joint With Structured Documents
Location: Palm 5	Date: 2011 05 16
Time: Q2	
Facilitator	Calvin BeeBe	Note taker(s)	Mary Kay McDaniel	
	
Attendee	Name	Affiliation	
X	Mary Kay McDaniel	Markam, Inc.	
	
Quorum Requirements Met:  Yes / No	
Agenda Topics
1.	Looking for guidance from SD – what direction should the group be looking to head?  The final rule for attachments will be in 2014 with requirement in 2016.  Do we create a guide for Op Notes for provider to payer exchange and leave the Op Notes for provider to provider alone - or do we merge the two uses?  Separate document templates or section template?
2.	Current industry initiatives
•	WG CDA R2 guide development, PIUC, Children’s Preventative
•	SDWG-Heath Story Guides, include overlap with Attachments OP notes, history and physical and discharge summary
•	S&I Initiative ONC, consolidation of HITSP (C32), IHE Health Story
•	esMD (CMS)-Electronic Submission of Medical Documents, Unstructured Physicians Orders and Progress Notes

Lenora – probably need to create new templates, but believes there would really have to be serious issues with the data to require the need for multiple companion documents.

Define a template id at the root level that would identify a claim attachment op note conformance 

Motion – look at one of the attachments to include in the October Ballot cycle.  Approved.  

HL7 FM Meeting Minutes
Location: Edelweiss	Date: 2011 05 16
Time: Q3/Q4	
Facilitator	Beat Heggli	Note taker(s)	Mary Kay McDaniel	
	
Attendee	Name	Affiliation	
X	Kathleen Connor	Microsoft	
X	Beat Heggli	HL7 Switzerland, nexus/schweiz	
X	Mary Kay McDaniel	Markam, Inc.	
	
Quorum Requirements Met:  Yes / No	
Agenda Topics
1.	Agenda review and approval 
2.	Review Mission, Charter and Process Review
The Charter changes from the Orlando Meeting were not applied to the web page.  Below is the verbiage that was requested.  The changes may not be applied until after the meeting minutes are approved.
Charter
The FM TC will produce normative standards for financial event messages. It will work closely with appropriate Work Groups to coordinate and consolidate references to financial instruments in all HL7 artifacts. The FM TC will monitor complementary financial and administrative information interchange standards other than HL7, and attempt to harmonize message content and vocabularies where possible.
Financial Management (FM) also collaborates with Patient Administration (PA) for cross-domain initiatives.
Formal Relationships With Other HL7 Work Groups
•	Patient Administration (collaborative) 
•	Attachments 
•	Medication 
•	Orders/Observations 
•	Government Projects 
•	Personnel Management 
Decision Making Practices
Date of Last Revision:
January 17, 2002, should change to either the date of the work group meeting or the date changed on the website… check with HL7 mgmt for confirmation
Action Item:  MK to follow-up with HL7 to determine what must be done to have changes made.
3.	Reviewed the FM WGM Minutes for October 2010, Cambridge
Approve October 2010 FM WGM Meeting Minutes
.VOTE	
Moved	Kathleen Connor	
Seconded	Beat Heggli	
Affirmative	Abstain	Opposed	
3	0	0	

4.	Brief discussion regarding September 2011 San Diego, CA Attendance.
Beat, Kathleen and MaryKay will attend.
Agenda will follow this agenda.  Monday AM will be spent in Plenary sessions.
5.	Reviewed changes to the GOM as sent out by Karen on Saturday 5/14/2011.
6.	Reviewed HL7 Fresh Look Taskforce, email from Rene Spronk, Saturday May 7th, 2011.
http://www.healthintersections.com.au/?p=137
WG members will be attending the meeting on Wednesday evening.
7.	Review of Switzerland billing codes
Kathleen and Beat reviewed all the billing codes used by Switzerland.

Actions: Q3, Monday	
Owner	Action Item	Due	
Mary Kay McDaniel	Follow-up with HL7 to learn next steps for changing FM Web Page, Charter 		

Tuesday
Financial Management
HL7 FM Meeting Minutes
Location: Edelweiss	Date: 2011 05 16
Time: Q1	
Facilitator	Kathleen Connor	Note taker(s)	Mary Kay McDaniel	
	
Attendee	Name	Affiliation	
X	Kathleen Connor	Microsoft	
	Beat Heggli	HL7 Switzerland, nexus/schweiz	
X	Mary Kay McDaniel	Markam, Inc.	
	
Quorum Requirements Met:  Yes / No	
Agenda Topics
1.	V2.X – ICD-10CM codes.
•	Started review of the 2.7/2.8 ICD codes.  Table 376 is the wrong table – named in the v2.X.
See below.  Seq#2 should be 396, not 376.
6.5.2  DG1 ‑ Diagnosis Segment
The DG1 segment contains patient diagnosis information of various types, for example, admitting, primary, etc.  The DG1 segment is used to send multiple diagnoses (for example, for medical records encoding).  It is also used when the FT1-19 - Diagnosis Code - FT1 does not provide sufficient information for a billing system.  This diagnosis coding should be distinguished from the clinical problem segment used by caregivers to manage the patient (see Chapter 12, Patient Care).  Coding methodologies are also defined.
HL7 Attribute Table - DG1 - Diagnosis
SEQ	LEN	C_LEN	DT	OPT	RP/#	TBL#	ITEM#	ELEMENT NAME	
1	1..4		SI	R			00375	Set ID - DG1	
2				W			00376	Diagnosis Coding Method 	
3			CWE	R		0051	00377	Diagnosis Code - DG1 	
4				W			00378	Diagnosis Description	

•	Table 396 does not contain ICD-10CM code value indicator.

1.	v3 artifacts and develop scope statements for reaffirmation ballot and check that we can clean up typos and make front matter current (like co-chairs and their company names)
Review V3 Normative - http://www.hl7.org/v3ne2011/html/welcome/introduction/index.html
•	v3 vocabulary links, wrappers and code types are out of date.  Would take major work to update via the publishing tools
•	The SSD [at last night’s meeting] asked our WG to do a write-up to explain the issue[s].
•	Reviewed the Quality Analysis Report
Actions: Q1, Tuesday	
Owner	Action Item	Due	
Mary Kay McDaniel	Follow-up with Beat to:  
•	fix in v2.8understand 
•	how to add codes to the table 376 		

HL7 FM Meeting Minutes
Location:  Edelweiss	Date: 2011 05 17
Time: Q2	
Facilitator	Kathleen Connor	Note taker(s)	Mary Kay McDaniel	
	
Attendee	Name	Affiliation	
X	Kathleen Connor	Microsoft	
X	Beat Heggli	HL7 Switzerland, nexus/schweiz	
X	Mary Kay McDaniel	Markam, Inc.	

Quorum Requirements Met:  Yes / No	

Agenda Topics

1.	v3 artifacts and develop scope statements for reaffirmation ballot and check that we can clean up typos and make front matter current (like co-chairs and their company names)
Review V3 Normative - http://www.hl7.org/v3ne2011/html/welcome/introduction/index.html

•	v3 vocabulary links, wrappers and code types are out of date.  Would take major work to update via the publishing tools
•	The SSD [at last night’s meeting] asked our WG to do a write-up to explain the issue[s].
•	Reviewed the Quality Analysis Report
During the morning break, Kathleen spoke with Woody.  Per Woody, for a reaffirmation we do not have to fix any errors – if we change anything then it is not a reaffirmation ballot.
Lynn will come in today Q3 to cover the logistics for the reaffirmation ballot.
2.	Formulated questions for our meeting with Lynn in Q3.
3.	Did analysis of claim attachment flow on the provider side to determine if any changes are needed. 
How will the information from the attachment generate a response from the clinical data repository?  Practice management systems are not sending CDA to clinical repositories and repositories are not sending CDA back to Practice Management systems.  Need a way to send v2.X messages then work into v3 messaging.

Clinical	Message	Practice Mgmt	Message	Payer	

Emergency Encounter	
Invoice
---
	
Patient Accounting System	
Claim
--	
Receives Claim	

Lab	
Query sent to clinical repository
?what message is this?	
Receives Request for Emergency Record	
Claim Attachment Request
---
	
Creates Request for additional information	
Produces response	
Response back
??What message is this???

Receives response	
Claim Attachment Response
--
	
Receives attachment	
		
Receives “835”	
Claim Payment
--	
Adjudicate Claim

Actions:  Q2 Tuesday	
Owner	Action Item	Due	
Kathleen Connor	Claim attachment work flow on the provider side.  Will this be Structured Documents or FM Domain?  If created in CDA, won’t ‘work’ with the existing V3		
Mary Kay McDaniel	•	Request meeting Attachment Workgroup
•	Request meeting with Structured Documents and Attachments workgroups, talk to Calvin
•	Talk to Keith

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HL7 FM Meeting Minutes
Location: Edelweiss	Date: 2011 05 17
Time: Q3	
Facilitator	Kathleen Connor	Note taker(s)	Mary Kay McDaniel	
	
Attendee	Name	Affiliation	
X	Kathleen Connor	Microsoft	
X	Beat Heggli	HL7 Switzerland, nexus/schweiz	
X	Mary Kay McDaniel	Markam, Inc.	
X	Lynn Laakso	HL7, International	

Quorum Requirements Met:  Yes / No	

Agenda Topics
1.	Lynn joined workgroup to discuss projects and workgroup health record.
a.	Project 330
http://www.hl7.org/Special/committees/fm/projects.cfm?action=edit&ProjectNumber=330
DSTU now needs to be balloted as normative or withdrawn or extended [once, for one year]

This project will create a new topic area within the FM domain to deal with Special Authorization. Special Authorization is the process by which insured patients are covered for products and services that are not part of their regular plan. The initial scope of the topic area will include interactions for requesting special authorizations, notification of special authorization dispositions and querying of special authorizations at both a summary and detail level.

Collaboration Efforts	Joginder Madra 
Michael van Campen	
Ballot Cycle Info		
Misc Notes	Jan 2011.  PMO reopened this project.  DSTU Accepting Comments thru 22-May-11 HL7 Version 3 Standard: Claims & Reimbursement; Special Authorization, Release 1
Sept. 2009: This is complete.  DSTU has been balloted.  Work on vocab may be necessary in future, but not part of this project.  Archiving project.
Project Resources will be drawn from the Financial Management Working Group
Ballot initially at DSTU
Reconcile implementer feedback after DSTU period
Ballot reconciled content as Normative	

b.	Project 332
http://www.hl7.org/Special/committees/fm/projects.cfm?action=edit&ProjectNumber=332
MITA – Medicaid Information Technology Architecture (MITA) Project
DSTU now needs to be balloted as normative or withdrawn or extended [once, for one year]
Kathleen asked what we have to do to withdraw these.
Resources, Templates – Notice of withdraw of proposed ANS Template
	Vote at this meeting to withdraw
	Fill out form [put both on the form] and send to Lynn
		
Cycle	
Balloted As Name	
Ballot Code	
Ballot Level/Iteration	
View Submitted NIB	

January 2009 Ballot Cycle 	
HL7 Version 3 Standard: Medicaid Information Technology Architecture (MITA) Development Framework, Release 1 (US Realm)	
V3_MITASG_R1_D2_2009JAN 	
Draft Standard for Trial Use 2 	
View NIB 	

September 2008 Ballot Cycle 	
HL7 Version 3 Standard: Medicaid Information Technology Architecture (MITA) Style Guide, Release 1	
V3_MITASG_R1_D1_2008SEP 	
Draft Standard for Trial Use 1 	

	

VOTE	Withdraw from Ballot	
Moved	Mary Kay McDaniel	
Seconded	Kathleen Connor	
Affirmative	Abstain	Opposed	
2	0	0	

c.	Project 362
Is completed, not on hold.  Lynn will speak to Don to change status to Complete.
Name	Account and Billing CMETs	
Sponsor(s)	Financial Management Work Group	
Steering Division	Structure & Semantic Design	
Description	Development of a universal realm set of CMETs needed for pricing, including A_ValuedItem, A_Benefit, and A_ProviderContract, and appropriate variants (e.g., basic, identified-confirmable, and identified) with requisite ballot artifacts, including a walk-through and schema. These are developed concurrently and iteratively, and there are no dependencies other than committee review, approval, and meeting ballot deadlines.	
Project Facilitator	Kathleen Connor	
Status	On Hold	
SD Approval Date	Oct 13, 2008 	
TSC Approval Date	Oct 28, 2008 	

2.	Workgroup Health
i.	Mission and Charter must be updated, see action item from yesterday.  Will send to steering committee for ratification and approval
ii.	3 year plan.  Must be reviewed and updated each meeting.  Send update information or has been reviewed and no changes to Dave Hamill or Lynn Lasco.

3.	v3 artifacts and develop scope statements for reaffirmation ballot and check that we can clean up typos and make front matter current (like cochairs and their company names)
Review V3 Normative - http://www.hl7.org/v3ne2011/html/welcome/introduction/index.html

Lynn Questions:
•	What do we need to do /steps for strictly reaffirmation ballot.  ANSI requires all standards be reaffirmed every 5 years.
o	Split by Domains
1.	Accounting and Billing Domain
2.	Claims & Reimbursement
RESPONSES.
o	Home/resources/templates/Project Scope Statement and Project approval Process.
o	Want the Project Scope Statement only
o	Name of the project will be reaffirmation
o	Ballot type will be normative
o	And under project intent use reaffirmation of a standard
o	Reader Notes:  Give to Don and he will include without making a change to the standard.  Inform all of the known errors/issues.  
o	Once project is entered into project insight it will get a new number.  Then check with Don to see if we need to create a NIB.

VOTE	Reaffirm both Account and Billing AND Claims and Reimbursement	
Moved	Kathleen	
Seconded	Mary Kay McDaniel	
Affirmative	Abstain	Opposed	
2	0	0	

4.	Lynn:  What do we need to do in preparation of new project:
Did analysis of claim attachment flow on the provider side to determine if any changes are needed. 
How will the information from the attachment generate a response from the clinical data repository?  Practice management systems are not sending CDA to clinical repositories and repositories are not sending CDA back to Practice Management systems.  Need a way to send v2.X messages then work into v3 messaging.
•	Add to 3 year plan.  Don’t need a project scope statement until we actually create a project.
o	3-way Domain Analysis Model for Attachments – How?  Steps?

Actions:  Q3, Tuesday 	
Owner	Action Item	Due	
Kathleen Connor	Follow-up with Joginder Madra, GPI
Project 330.  Special Authorization.  DSTU.  Need to ballot in September 
http://www.hl7.org/Special/committees/fm/projects.cfm?action=edit&ProjectNumber=330
		
Kathleen Connor	Reaffirmation ballot.
Normative Edition 2010.
Accounting and Billing Name is wrong
Should be Account and Billing		

Tuesday, Q4
Government Services
Meeting Minutes.
Review and approved the charter.
Review of workgroup charter.
Cross Realm transfer EHR of patients.
Coalition Forces – need to be able to transfer information.  CDA is bound to a realm 
NATO medical IT.  Working with all coalition forces.  Looking at building a new realm.  

Federal Health Architecture Interoperability Model 
Federal Health Informational Modeling and Standards
Get information model behind the HITSP stuff, wanted information in context
Basis for the FEA information Model
Pushing Model-Driven Health Tools [MDHT]

Federal records preservation Law – 75 years for ‘person’.  DOD/VA, all is 75.  

2 Quarters Q3/Q4 for San Diego, in September
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Wednesday
Financial Management

HL7 FM Meeting Minutes
Location: Edelweiss	Date: 2011 05 18
Time: Q1/Q2	
Facilitator	Kathleen Connor	Note taker(s)	Mary Kay McDaniel	
	
Attendee	Name	Affiliation	
X	Kathleen Connor	Microsoft	
X	Beat Heggli	HL7 Switzerland, nexus/schweiz	
X	Mary Kay McDaniel	Markam, Inc.	

	
Quorum Requirements Met:  Yes / No	

Agenda Topics
1.	Compete Paperwork for project 332 MITA work products withdrawl and extending project 330 special authorizations

HL7 FM Meeting Minutes
Location: Edelweiss	Date: 2011 05 18
Time: Q3	
Facilitator	Mary Kay McDaniel	Note taker(s)	Kathleen Connor	
	
Attendee	Name	Affiliation	
X	Kathleen Connor	Microsoft	
X	Beat Heggli	HL7 Switzerland, nexus/schweiz	
X	Mary Kay McDaniel	Markam, Inc.	

	
Quorum Requirements Met:  Yes / No	

Agenda Topics

1.	V2.X – request for additional data elements.
#673:  Does PC want to hand over the entire chapter or they do the work.  This use case is FM, but the chapter is not an FM chapter.  

See http://www.hl7.org/memonly/dbsub.cfm , project 673

V 2.8 HL7 Proposal	
Change Request ID:	To be Defined	
File Name:	Authorization Referral Proposal	
Description:	Authorization & Referral Updates 	
Status:	New Proposal	
Sponsoring Person	Hans Buitendijk – Ilene Yost	
Sponsoring Business Unit	Siemens Healthcare	
Date Originated:	09/15/2010	
Date HL7 approved:		
Backward Compatible:	Yes	
Forward Compatible:	Yes	
HL7 Status & Date		

1.	I'm writing no behalf of the Patient Administration WG to let you know the disposition of the proposal submitted by you into the proposal database (ID 673), regarding the addition of AUT and REF to A01, A04, A08 and A13, and the addition of various fields to AUT and REF: 

Disposition: Referred to Financial Management/Patient Care 

Note: The WG suggests that the submitter bring this to the custodian for the Financial Management Chapter (6) for possible inclusing within authorization contstructs defined there. If it is felt that it is not within the domain of financial management, then the WG suggests that the submitter first approach the Patient Referral custodians (Patient Care), for inclusion of the proposed fields to segements RF1 and AUT before PA considers including these into the aforementioned ADT events. 

Please let me know if you have any questions/concerns, 

2.	Create Read Me file for Ballot
a.	Reader Notes:  Give to Don and he will include without making a change to the standard.  Inform all of the known errors/issues.  
http://www.hl7.org/v3ne2011/html/welcome/introduction/index.html

HL7 FM Meeting Minutes
Location: 	Date: 2011 05 18
Time: Q4	
Facilitator	Mary Kay McDaniel	Note taker(s)	Kathleen Connor	
	
Attendee	Name	Affiliation	
X	Kathleen Connor	Microsoft	
X	Beat Heggli	HL7 Switzerland, nexus/schweiz	
X	Mary Kay McDaniel	Markam, Inc.	
X	Jon Farmer	Apelon	
X	Max Walker	Health Vic	
X	Mike Davis	VA	
X	Richard Thorson	SAMHSA	
X	Jim Kretz	SAMHSA	
X	Serafina Versaggi	SAMHSA	
	
Quorum Requirements Met:  Yes / No	
Agenda Topics
1.	Claims Aware SMIME
Kathleen Connor gave a presentation on ‘claiming’ as in claiming who you are.

Thursday
Financial Management

HL7 FM Meeting Minutes
Location: Edelweiss	Date: 2011 05 19
Time: Q1	
Facilitator	Kathleen Connor	Note taker(s)		
	
Attendee	Name	Affiliation	
X	Kathleen Connor	Microsoft	
X	Beat Heggli	HL7 Switzerland, nexus/schweiz	
X	Mary Kay McDaniel	Markam, Inc.	

	
Quorum Requirements Met:  Yes / No	
Agenda Topics
1.	Continue Read Me file for Ballot
a.	Reader Notes:  Give to Don and he will include without making a change to the standard.  Inform all of the known errors/issues.  
http://www.hl7.org/v3ne2011/html/welcome/introduction/index.html

HL7 FM Meeting Minutes
Location: 	Date: 2011 05 19
Time: Q2	
Facilitator	Mary Kay McDaniel	Note taker(s)	Kathleen Connor	
	
Attendee	Name	Affiliation	
X	Kathleen Connor	Microsoft	
X	Beat Heggli	HL7 Switzerland, nexus/schweiz	
X	Mary Kay McDaniel	Markam, Inc.	

	
Quorum Requirements Met:  Yes / No	
Agenda Topics
1.	Completed Read Me file for Ballot and voted to approve.
a.	Reader Notes:  Give to Don and he will include without making a change to the standard.  Inform all of the known errors/issues.  
VOTE	Approve the Reaffirmation ballot Read Me file	
Moved	Kathleen	
Seconded	Beat Heggli	
Affirmative	Abstain	Opposed	
2	0	0	

2.	Calls will be every other week, starting June 16, 2011 at 2pm ET.  Conference call has been set up in conference center.

Meeting Action Items:

Actions: Q3, Monday	
Owner	Action Item	Due	
Mary Kay McDaniel	Follow-up with HL7 to learn next steps for changing FM Web Page, Charter 	Must send to steering division for approval /ratification .

Sent 2011 05 19	
			
Actions: Q1, Tuesday	
Owner	Action Item	Due	
Mary Kay McDaniel	Follow-up with Beat to:  
•	fix in v2.8 understand 
•	how to add codes to the table 0376 	Done
2011 05 19	
			
Actions:  Q2 Tuesday	
Owner	Action Item	Due	
Kathleen Connor	Claim attachment work flow on the provider side.  Will this be Structured Documents or FM Domain?  If created in CDA, won’t ‘work’ with the existing V3	Done
Email to SD/SSD, Calvin Beebe
2011 05 19	
Mary Kay McDaniel	•	Request meeting Attachment Workgroup
•	Request meeting with Structured Documents and Attachments workgroups, talk to Calvin
•	Talk to Keith
	•	Talked to Attachment WG about MSG
Done
2011 05 19.  Will work through SD/SSD.	
Actions:  Q3, Tuesday 	
Owner	Action Item	Due	
Kathleen Connor	Follow-up with Joginder Madra, GPI
Project 330.  Special Authorization.  DSTU.  Need to ballot in September 
http://www.hl7.org/Special/committees/fm/projects.cfm?action=edit&ProjectNumber=330

Beat followed up with Jay Zimmerman who asked that we extend for one year.
	Done 
2011 05 19	
Kathleen Connor	Reaffirmation ballot.
Normative Edition 2010.
Accounting and Billing Name is wrong
Should be Account and Billing	Done 
2011 05 19	
Actions:  Q2, Thursday 	
Owner	Action Item	Due	
Mary Kay McDaniel	Put together documentation for claim attachments for the HL7 Policy Group.  Check with AHCCCS and describe the issues 		

Next WGM Meeting / Preliminary Agenda Items

September, 2011
1.	Agenda Review and Approval
2.	Review Mission, Charter and 3 year plan.
a.	Mission and Charter Changes must go to SSD for approval and ratification, email co-chairs
b.	3 Yr Plan.  Review, changes or no update email to Dave Hamill or Lynn Laakso
3.	Review and Approve Meeting Minutes from last interim call
4.	V2.X review/updates/changes if needed
5.	Ballot review for reaffirmation ballot for Account and Billing & Claims and Reimbursement

**Meet with Claim Attachments and SD to discuss 3-way DAM for messages.

Interim Call, June 16, 2011
1.	Agenda Review and Approval
2.	Review Links Within the Reaffirmation Ballot
3.	Review and Approve Meeting Minutes from WGM
4.	Updates regarding v2.X 673 Project Request
5.	Updates regarding claim attachment PMS/PAS messages
6.	Adjourn