electronic Submission of Medical
Documentation (esMD)
electronic Determination of Coverage (eDoC)
Workgroup
Oxygen Concentrators and Portable Oxygen (OCPO)
User Story Launch
September 24, 2014
Sponsors & Support
PAMELA DURBIN, RN, BSN,CDS, ISSO
Health Insurance Specialist, COR II
CMS / OFM / Provider Compliance Group
DAN KALWA
Health Insurance Specialist,
CMS / OESS
MARK D PILLEY, MD AAFP, AADEP,
ABQAURP
Medical Director
Strategic Health Solutions, LLC
MICHAEL HANDRIGAN, MD
Medical Officer
VIET NGUYEN, MD
CMS / OFM / Provider Compliance Group
Chief Medical Information Officer
ROBERT DIETERLE,
Systems Made Simple, Inc.
Initiative Coordinator
SWETA LADWA, MPH
Project Manager / Epidemiology
ESAC, Inc.
2
Agenda / Presenter
Opening Remarks
ROBERT DIETERLE
S&I Process
Overview of eDoC Workgroup
Related Initiatives
Description of Oxygen User Story
MARK PILLEY, MD
Structured Data
Mapping Oxygen to eDoC and Other Initiatives
Timeline and Summary
SWETA LADWA, MPH
Closing Remarks
ROBERT DIETERLE
3
Standards & Interoperability (S&I) Framework
“…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.”
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.
http://siframework.org/whatis.html
Solution Development Lifecycle
eDoC Phase
Charter
Use Case
Standards
Harmonization
Implementation
Guidance &
Piloting
Details
•
•
•
Challenge statement
Timelines and milestones
Goals and outcomes
•
•
•
•
•
•
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
•
•
•
•
•
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
•
•
•
•
•
Create implementation guide(s)
Identify pilot participants
Develop pilot / demonstration plan
Evaluate success
Modify Implementation guide(s) as
required
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
eDoC
Workgroup
Charter
Use Case
Harmonization
Pilots
Sub-Workgroups
User Stories
Structured Data
• Power Mobility
Devices
• Lower Limb
Prostheses
• Home Health
Services
• Oxygen
Concentrators and
Portable Oxygen
• Determine documentation
requirements
• Evaluate appropriate
clinical elements
• Clinical Vocabularies
• Define CCDA template
Consolidated CDA
Documentation
Templates
• Define template
requirements
Transport
• ASC X12 275, 278, 277
• CONNECT
• Define template workflow • Direct
• Define EHR data capture
requirements
• Specify storage
requirements
Structured Data Capture
esMD eDoC IGs
7
esMD Background
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.
Before esMD:
Review Contractor
Request
Letter
Paper Medical
Record
Provider
Phase 1:
Phase I of esMD was
implemented in September of
2011. It enabled Providers to
send Medical Documentation
electronically
Doc’n
Request
Letter
electronic
The ONC S&I Framework
Electronic Submission of Medical
Documentation (esMD) initiative is
developing solutions to support an
entirely electronic documentation
request.
Phase 2:
electronic
electronic
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)
2. Send eMDRs
• A payer sends an eMDR
to a registered provider
1. Register to
Receive eMDRs
esMD Phase 2
• A provider
electronically sends
medical documentation
to a payer in response
to an eMDR
3. Send Medical
Documentation
esMD Phase 1
9
Electronic Determination of Coverage (eDoC)
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 standardsbased 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)
10
eDoC General Workflow
Patient
LCMP / IDTF
Physician
Specialist /
Service Provider
Templates
and Rules
Payer
11
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)
Inpatient Hospitals
 No Documentation – 0.3%
Durable Medical
 Insufficient Documentation Errors – 73.2%
Equipment
 Oxygen Concentrators (E1390) - $1 Billion –
75.6% Overpayment Rate
 Claims Containing Errors – 68.1%
(Medicare FFS 2013 Improper Payment Rate Report –
Supplementary Appendices )
Improper Payment
Improper Payment
Rate
Amount
Service Type
Physician/Lab/Ambulance
8.0%
$9.4B
58.2%
$5.7B
10.5%
$9.5B
8.2%
$11.4B
10.1%
$36.0B
Non-Inpatient Hospital
Facilities
Overall
 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
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 E1391
FLOW RATE, EACH
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 OR
MASK, AND TUBING
K0738
14
OCPO Reviews
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.”
15
OCPO Reviews
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
16
OCPO – Order Requirements
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)
– .
17
OCPO Definition
PORTABLE GASEOUS OXYGEN SYSTEM, RENTAL; INCLUDES PORTABLE
CONTAINER, REGULATOR, FLOWMETER, HUMIDIFIER, CANNULA OR MASK, E0431
AND TUBING
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
PORTABLE LIQUID OXYGEN SYSTEM, RENTAL; INCLUDES PORTABLE
CONTAINER, SUPPLY RESERVOIR, HUMIDIFIER, FLOWMETER, REFILL
ADAPTOR, CONTENTS GAUGE, CANNULA OR MASK, AND TUBING
• 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.
E0433
E0434
AFFORDABLE
CARE ACT (ACA)
6407
REQUIREMENTS
18
OCPO Submission Methods
OCPO Documentation submission methods
– Mail – USPS, FedEx, UPS
– Fax – to secured site
– CD/DVD - Password Protected
– esMD – via HIH
19
Types of Review
Order Validation – New
Prepay Review - Ongoing
Post-pay Review - Ongoing
20
Supplier
Ordering
Physician/Practitioner
Beneficiary
Request Process for OCPO
Visits Physician/ Practitioner – Opt Office / ED
Hospitalized for Respiratory Failure / Exacerbation of COPD
/ Pneumonia, etc. – Medical Documentation substantiates
Requires &/or Benefits from Supplemental O2
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
IDTF/Hosp/Home
Orders ABGs,
Oximetry, 6-minute
walk, PFTs, VO2 Max,
etc.
Refers for Sleep Study
Writes, signs, and dates DWO and
Completes the CMN
Receives/Files
F2F visit progress
note, DWO, and
CMN
Completes
OCPO
Delivery
Obtains
Proof of
Delivery
(POD)
Submits Documentation
Package including:
•
•
•
•
•
In person visit or F2F visit
DWO
CMN
POD
Other Supporting Documentation
21
Supplier
Ordering
Physician/Practitioner
Beneficiary
Request Process for OCPO - Order Validation
Visits Physician/ Practitioner – Opt Office / ED
Hospitalized for Respiratory Failure / Exacerbation of COPD
/ Pneumonia, etc. – Medical Documentation substantiates
Requires &/or Benefits from Supplemental O2
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 and
Completes the CMN
Receives/Files
F2F visit progress
note, DWO, and
CMN
Completes
OCPO
Delivery
IDTF/Hosp/Home
Orders ABGs,
Oximetry, 6-minute
walk, PFTs, VO2 Max,
etc.
Refers for Sleep Study
DWO – Order
Validation
Obtains
Proof of
Delivery
(POD)
Submits Documentation
Package including:
•
•
•
•
In person visit or F2F visit
DWO
CMN POD
Other Supporting Documentation
22
eDoC General Workflow
Patient
IDTF / Hosp / Opt Lab
Physician
DME Supplier
Templates
and Rules
Payer
23
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 hypoxiarelated 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 faceto-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
Links
esMD Initiative:
http://wiki.siframework.org/esMD+Initiative
esMD Program:
http://www.cms.gov/esmd
esMD eDoC Initiative: http://wiki.siframework.org/esMD++Electronic+Determination+of+Coverage
Contact Information
Robert Dieterle – esMD Initiative Coordinator (rdieterle@enablecare.us)
Sweta Ladwa – ESAC (sweta.ladwa@esacinc.com )
Dan Kalwa – CMS (Daniel.Kalwa@cms.hhs.gov)
Pamela Durbin – CMS (Pamela.Durbin@cms.hhs.gov)
Dr Mark Pilley – Co Lead (m.pilley@strategichs.com)
Dr. Viet Nguyen – Co Lead (viet.nguyen@systemsmadesimple.com
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 OCPO
http://www.cms.gov/medicare-coverage-database/details/ncddetails.aspx?NCDId=169&ncdver=1&DocID=240.2&SearchType=A
dvanced&bc=IAAAABAAAAAA&
CMS MLN Matters - https://www.cms.gov/Outreach-and
Education/Medicare-Learning-NetworkMLN/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, at
http://www.cms.gov.Regulations-andGuidance/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-andGuidance/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/MedicareLearning-NetworkMLN/MLNMattersArticles/downloads/MM7820.pdf
The official instruction, CR7820, is located at
http://www.cms.gov/Regulations-andGuidance/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 OCPO
Jurisdiction A LCD
Jurisdiction B LCD
Jurisdiction C LCD
Jurisdiction D LCD
http://www.cms.gov/medicare-coveragedatabase/search/searchresults.aspx?SearchType=Advanced&CoverageSelection=Lo
cal&ArticleType=SAD%7cEd&PolicyType=Both&s=All&Cntrct
rType=10&KeyWord=Oxygen+and+Oxygen+Equipment&Key
WordLookUp=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 LCD
http://www.cms.gov/medicare-coverage-database/details/lcddetails.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&KeyWordSearch
Type=Exact&kq=true&bc=IAAAABAAAAAAAA%3d%3d&
Jurisdiction B LCD
http://www.cms.gov/medicare-coverage-database/details/lcddetails.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&KeyWordSearch
Type=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-coveragedatabase/details/lcddetails.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$$$IAAAABAAAAAAAA$$$$$$***&session=phelks45atn2e
bmyr5z3ot55&kq=876734436
Jurisdiction D LCD
http://www.cms.gov/medicare-coverage-database/shared/handlers/highwire.ashx?url=http://www.cms.gov/medicare-coveragedatabase/details/lcddetails.aspx@@@LCDId$$$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=phelks45atn2e
bmyr5z3ot55&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
eDoC OCPO Timeline
Sept ‘14
Oct ‘14
Nov ‘14
Dec ‘ 14
Jan ‘15
Feb ‘15
Mar‘15
Apr ‘15
Kick-Off
OCPO – User Story Development
Sub Workgroup LLP Structured Data
Standards/Data
Model/Harmonization
OCPO Pilots
OCPO
Implementation
Guide
38
eDoC Timeline
We are here
October ‘13 December ‘13 February ‘14 April ‘14
June ‘14
August ‘14
October ‘14 December ‘14 February ‘15
Electronic Determination of Coverage WG
PMD and LLP e-Clinical Template Pilots
LLP User Story
Home Health
User Story
Oxygen Concentrators and
Portable Oxygen User Story
eDoC Harmonization and Structured Data
eDoC Administrative Documents Templates IG for HL7 Ballot
eDoC HL7 Clinical Documents for Payers Set 1 Ballot Reconciliation
Call for Public Participation
As 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
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Thank You
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