Eye Care Charge Posting

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Eye Care Charge Posting (EC-CHG) collects and posts timely billable claims, including both radiology and eye care procedures.

Summary

The Eye Care Charge Posting Integration Profile specifies the exchange of information from department ordering systems to billing systems regarding charges associated with particular procedures. It also defines the communication between patient registration systems and billing systems about patient demographics, accounts, insurance, and guarantors. The Charge Posted Transaction contains all of the required procedure data to generate a claim. The procedure information is obtained from acquisition modalities via transactions from the Eye Care Workflow Integration Profile. The goal of including this transaction in the IHE Technical Framework is to standardize the Charge Posted Transaction to a billing system, thus reducing system interface installation time. Additionally, the Charge Posted Transaction reduces the need of the billing system to have knowledge of the eye care internals. The result is that the billing system will receive more complete, timely and accurate data.

Note: This version of the IHE EYECARE TF does not include professional reporting, and therefore has not used the roles of Report Creator and Evidence Creator. This will be addressed in the future and will most likely be part of Charge Posting.

Diagram ChargePosting small.jpg

Benefits

The main benefit is that performed procedures can be billed for in a timely and accurate manner. With specifications for the interactions, this reduces the need of the billing system to have Events that may trigger a charge posted transaction are Procedure Ordered, Procedure Scheduled, and Procedure Completed.

Details

A new patient calls and makes an appointment for a visit. The patient arrives at the clinic on the date scheduled. The front desk clerk asks the new patient to fill out the rest of their demographics and insurance information on a standard paper form. The clerk accepts completed documents and enters the information into the ADT Patient Registration. The registration system validates the information and distributes the necessary demographics information to the Department System Scheduler/Order Filler system. The patient is then led through a series of rooms where standard tests are usually performed on new patients. These tests could include non-mydriatic fundus photos, refraction, topography, pachymetry, and vision exams. A technician normally performs these tests. The patient is then taken to a room to be seen by the physician. The physician will normally perform an external eye, a slit-lamp biomicroscopic and a fundus exam. The physician may then perform additional examinations and/or procedures that may include gonioscopy, extended sensorimotor exam, removal of foreign bodies, insertion of plugs, application of eye patches, protective contact lenses, etc. The Department System Scheduler/Order Filler will send charges to the Charge Processor. If additional tests that require the use of diagnostic and/or imaging devices (modalities) are required, then an order will be created and the patient will be scheduled for those tests in Department System Scheduler/Order Filler. The patient will arrive at the department responsible for filling the orders issued by the doctor. The technician will perform the diagnostic procedures on the patient using the specified modality. When the diagnostic procedures have been completed, the Department System Scheduler/Order Filler will send charges to the Charge Processor.

Systems Affected

  • Practice Management System or Enterprise-wide information systems that manage patient registration and services ordering (i.e., admit-discharge-transfer (ADT)/registration system and hospital information system (HIS))
  • Electronic Medical Record System or Departmental information systems that manage department scheduling
  • Acquisition modalities, e.g., fundus cameras, ultrasound machines, ophthalmic tomography devices, slit-lamp biomicroscopes


Actors & Transactions:

Charge Posting transaction diagram.jpg

Specification

Profile Status: Final Text

Documents: Eyecare Technical Framework


Underlying Standards:

See Also

http://one.aao.org/CE/PracticeGuidelines/Information_Technology.aspx