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  1. FHIR Specification Feedback
  2. FHIR-38644

Add provider descriptions for patients to both encounter and claim level

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • US Da Vinci Patient Cost Transparency (PCT) (FHIR)
    • current
    • Financial Mgmt
    • Formal Specification
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      We feel the existing providerEventMethodology extension on the GFE profiles meets this need. Leave this extension at the header but change to MS, also add it to Claim.item (0..1) MS. Will update the description of that extension to read:

      "This extension is used for indicating the method a provider used to group services, and those providing such services, beyond what may be indicated through DRGs that the payer or patient may find helpful (e.g. grouping services by a standardized episode of care definition). This is provider generated text and should not be modified by the payer."

      Add the following examples to a new "Notes on Fields" section on the GFE profiles (see AEOB profile for an example"

      ".providerEventMethodology: Some usage examples below:
      Example 1: A provider is offering both a surgical and a drug therapy based option to the patient. The provider would be able to add text such as "Surgical care option" and "Drug therapy option" to the GFE so that the patient could easy see what was intended without having to understand different CPT codes.

      Example 2: A provider added services to a previously submitted GFE, they would be able to say "Added physical therapist on Sep 18, ignore estimates submitted on Sep 17"."

      Add a comment to the extension slice noting that the extension definition contains more detail. 

      Update the short description of this extension on the GFE profiles to read: 
      "The method a provider used to group services"

      Show
      We feel the existing providerEventMethodology extension on the GFE profiles meets this need. Leave this extension at the header but change to MS, also add it to Claim.item (0..1) MS. Will update the description of that extension to read: "This extension is used for indicating the method a provider used to group services, and those providing such services, beyond what may be indicated through DRGs that the payer or patient may find helpful (e.g. grouping services by a standardized episode of care definition). This is provider generated text and should not be modified by the payer." Add the following examples to a new "Notes on Fields" section on the GFE profiles (see AEOB profile for an example" ". providerEventMethodology : Some usage examples below: Example 1: A provider is offering both a surgical and a drug therapy based option to the patient. The provider would be able to add text such as "Surgical care option" and "Drug therapy option" to the GFE so that the patient could easy see what was intended without having to understand different CPT codes. Example 2: A provider added services to a previously submitted GFE, they would be able to say "Added physical therapist on Sep 18, ignore estimates submitted on Sep 17"." Add a comment to the extension slice noting that the extension definition contains more detail.  Update the short description of this extension on the GFE profiles to read:  "The method a provider used to group services"
    • Rick Geimer/Paul Knapp: 9-0-1
    • Clarification
    • Non-substantive

    Description

      Patients need additional context to understand the AEOB, especially in cases where they are getting cost estimates for several care options or a provider has submitted an updated GFE.

      I want both a per-claim text field and "encounter" level text field where a provider can submit explanatory text that will be displayed to the patient when they are viewing the AEOB. 

      Example 1: A provider is offering both a surgical and a drug therapy based option to the patient. The provider would be able to add text such as "Surgical care option" and "Drug therapy option" to the GFE so that the patient could easy see what was intended without having to understand different CPT codes.

      Example 2: A provider added services to a previously submitted GFE, they would be able to say "Added physical therapist on Sep 18, ignore estimates submitted on Sep 17".

      Adding descriptions would be OPTIONAL for the providers, but payers SHALL pass that text along to the patient, without modification other than formatting.

      We may wish to limit the allowed length of the text to some reasonable amount to limit impact on payer system storage.

       

       

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            deroode David DeRoode
            chris_cioffi Chris Cioffi
            Chris Cioffi
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              Updated:
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