This is excellent news, David... thanks for letting us know. The AOA meeting with software vendors is set for Aug. 16th in Chicago. I look forward to "comparing notes" at the conclusion of these two meetings.
-Chris At 09:36 AM 6/29/02 -0400, David Kibbe wrote: >Chris: here's an update...ten medical specialty societies' >representatives will meet in mid-August for a full day to discuss >HIPAA-EDI, vendor readiness issues, and CMS response to our >concerns. We've made a lot of progress in terms of self-education and >awareness that a proactive approach by the membership organizations that >represent the majority of America's physicians is needed. > >The group is staying "close to home" right now, that is, limiting initial >work to physicians' membership organizations. However, I have discussed >the AOA's progress, and there is interest and openess to alliances or >collaboration later on. > >Keep on truckin' DCK > >-----Original Message----- >From: Christopher J. Feahr, OD >[<mailto:[EMAIL PROTECTED]>mailto:[EMAIL PROTECTED]] >Sent: Friday, June 28, 2002 8:05 PM >To: [EMAIL PROTECTED] >Subject: Re: 270/271 Question(s) > >Bruce, >I'm glad to see that the vision industry is not alone with this type of >headache! If there is any way payors could simplify benefit plan rules, I >would be eternally grateful. In the meantime, however, providers are >entitled to have this information delivered to them in a usable, electronic >form. Generally, this adjudication logic is already described in narrative >form somewhere in the provider's office. Returning this as free text in a >271 will be about as helpful as finding it in his own provider manual or >having it read to him over the phone. But to be *really* useful in >answering the specific question that he or the patient has, it should be in >a machine-understandable form. > >One way or the other, all "provider eligibility queries" feel like "pricing >queries" to me. Either the patient or the provider wants to know what >something will cost and/or what the associated reimbursement or write-off >might be... both now and later on, as treatment progresses. As I just said >in my response to the "pre-determination" question, I believe that we are >eventually going to have to codify all of the logical elements that payors >might conceivably use in eligibility/payment formulas. That way, the payor >could return the actual parameter values that apply to Patient X with Plan >Y, and the provider system could insert those into the [relatively static] >formulas that he has pre-programmed in his system for Plan Y, thereby >enabling his system to answer whatever "pricing" question the patient or >provider was asking. For the less capable provider, you could also return >the free text description of benefits in an MSG segment. > >This will require a collaborative effort among payors to describe all the >different formulas that have been dreamed up. From that, we should be able >to develop standard terminology for the logical elements and assign a LOINC >code to each element. Presumably, this logic is already codified in each >payor's adjudication system, meaning that someone has already gone through >this process. Hopefully, this would also have a stabilizing effect on plan >structures and logic. > >How does this approach strike payors? Wouldn't this provider-capability >reduce phone calls from provider offices? > >Regards, >Chris > >At 09:49 AM 6/28/02 -0400, you wrote: > > >How am I supposed to code the following benefits in a 271? And these are > >only a sample. Should I just "give up" and put everything that doesn't > >readily code in an MSG segment? Is there any explanation of what the codes > >mean anywhere? What is everyone else doing? > > > >Participating Hospital Emergency room covered: 100% after $50 copay > >EB01 = A or B?, EB03 = 51 or 53? EB07 = 50 EB08 = 100 > > > > > >Specialist Office Visit Copay: Same As Any Other Physician > >EB01 = B EB03 = 98? Professional (Physician) Visit - Office EB05 = > >Specialist Same As Any Other Physician > > > > > >and finally: > > > >Inpatient Hospital benefit: $250 deductible, then $150 Copay per day up to > >5 days per admission then 90% > > > >??? - MSG? > > > > > > > > > > > >********************************************************************** > >To be removed from this list, send a message to: > [EMAIL PROTECTED] > >Please note that it may take up to 72 hours to process your request. > > > >====================================================== > >The WEDI SNIP listserv to which you are subscribed is not moderated. The > >discussions on this listserv therefore represent the views of the > >individual participants, and do not necessarily represent the views of the > >WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official > >opinion, post your question to the WEDI SNIP Issues Database at > ><http://snip.wedi.org/tracking/>http://snip.wedi.org/tracking/. > >Posting of advertisements or other commercial use of this listserv is > >specifically prohibited. > >Christopher J. Feahr, OD ><http://visiondatastandard.org>http://visiondatastandard.org >[EMAIL PROTECTED] >Cell/Pager: 707-529-2268 > > >********************************************************************** >To be removed from this list, send a message to: [EMAIL PROTECTED] >Please note that it may take up to 72 hours to process your request. > >====================================================== >The WEDI SNIP listserv to which you are subscribed is not moderated. The >discussions on this listserv therefore represent the views of the >individual participants, and do not necessarily represent the views of the >WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official >opinion, post your question to the WEDI SNIP Issues Database at ><http://snip.wedi.org/tracking/>http://snip.wedi.org/tracking/. > >Posting of advertisements or other commercial use of this listserv is >specifically prohibited. > > >********************************************************************** >To be removed from this list, send a message to: [EMAIL PROTECTED] >Please note that it may take up to 72 hours to process your request. > > >The WEDI SNIP listserv to which you are subscribed is not moderated. The >discussions on this listserv therefore represent the views of the >individual participants, and do not necessarily represent the views of the >WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official >opinion, post your question to the WEDI SNIP Issues Database at >http://snip.wedi.org/tracking/. >Posting of advertisements or other commercial use of this listserv is >specifically prohibited. Christopher J. Feahr, OD http://visiondatastandard.org [EMAIL PROTECTED] Cell/Pager: 707-529-2268 ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request. ====================================================== The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited.
