Title: Source of Payment Typology:
1- Source of Payment Typology
- A New National Standard
- Roxanne Andrews, PhD
- Chair, Source of Payment TypologySubcommittee
2Agenda
- Overview of Typology Subcommittee
- Overview of Typology
- Implementation of Typology
- Activities over the Coming Year
3THE SUBCOMMITTEE
4Source of Payment Tpology Subcommittee
- Subcommittee of the Data Standards Committee
- Purpose to create and refine a standard to allow
consistent reporting of payer data to public
health agencies for health care services and
research - The Payer Typology is an early project for the
Consortium (starting in 2000) with continual
successes over the years
5Typology Subcommittee
- Patricia Andrews
- Louisiana State University Health Sciences Center
- Louisiana Tumor Registry
- Amy Bernstein
- CDC/NCHS
- Robert Bolden
- Georgia Hospital Association
- Robert Davis
- Consultant
- Sheila Frank
- Consultant
- Regina Gibson
- Blue Cross Blue Shield Michigan
- Marjorie Greenberg
- CDC/NCHS
- Tammara Jean Paul
- CDC/NCHS
- Hetty Khan
- CDC/NCHS
- Starla Ledbetter
- California Office of Statewide Health Planning
and Development - Denise Love
- National Association of Health Data Organizations
(NAHDO) - Anna Orlova
- Johns Hopkins School of Public Health
6Typology Sub-Committee
- Charlotte Pease
- Maine Health Data Organization
- Barbara A. Rudolph
- University of Wisconsin - Madison
- Cristal Schoenfelder
- CA Office for Statewide Health Planning and
Development - Gale Scott
- Tampa General Hospital
- Castine Verrill
- CDC/NCCDPHP
- Michelle Williamson
- CDC/NCHS
7SOP Typology Subcommittee Phases of Activities
- Developed standard payer codes, definitions
user guide - Worked with national standards groups to have the
SOP Typology accepted - ANSI X12
- NUBC
- HL7 ( PHIN)
- Implementation Education/Outreach
- Maintenance
8SOURCE OF PAYMENT TYPOLOGY
9 Importance of Source of Payment Data
- Source of payment data used for wide variety of
public health and healthcare research - Critical need for policymakers and researchers
examining effects of payment policy to compare
across databases - Standardized source of payment data needed to
monitor healthcare trends such as access to
healthcare and treatment patterns across payer
categories
10Payer Coding for National Quality Monitoring
Risk-adjusted Inpatient Heart Attack Mortality
11Payer Coding for Tracking National Hospital Costs
12Issues with Payer in Administrative Data
Collected Today
- No uniformity across states
- NO DEFINITIONS FOR CONCEPTS
- Missing Concepts
- For example bad debt and charity care
- Overlapping Concepts
- For example Health Maintenance Organization
- Obscure Concepts
- For example Central Certification
13Current Claim Filing IndicatorList Used in 837
Implementation Guides
CH Champus CI Commercial Insurance Co. DS
Disability HM Health Maintenance
Organization LI Liability LM Liability
Medical MA Medicare Part A MB Medicare Part
B MC Medicaid OF Other Federal Program TV
Title V VA Veteran Administration Plan WC
Workers Compensation Health Claim ZZ Mutually
Defined / Unknown
09 Self-pay 10 Central Certification 11 Other
Non-Federal Programs 12 Preferred Provider
Organization (PPO) 13 Point of Service (POS) 14
Exclusive Provider Organization (EPO) 15
Indemnity Insurance 16 Health Maintenance
Organization (HMO) Medicare Risk AM Automobile
Medical BL Blue Cross/Blue Shield
14SolutionSource of Payment Typology
- Designed to improve the organization of the
payment categories - Provides robust definitions
- Hierarchical structure
- Definitions for ALL the concepts
- Companion User Guide for each version of the
Source of Payment Typology
15Major Payer Categories
1 2 3 4 5 6 7 8 9 Medicare Medicaid Other Government (not Medicare, Medicaid or corrections) Department of Corrections Private Health Insurance Blue Cross/Blue Shield Managed Care, unspecified () No payment from organization Miscellaneous/other
16Source of Payment Typology Categories Major and
Sub-classifications
1 MEDICARE
11 Medicare (Managed Care)
111 Medicare HMO
112 Medicare PPO
113 Medicare POS
119 Medicare Managed Care Other
12 Medicare (Non-managed Care)
121 Medicare FFS
122 Medicare Drug Benefit
123 Medicare Medical Savings Account (MSA)
129 Medicare Non-managed Care Other
19 Medicare Other
17Second Level Sub-classification
2 MEDICAID
21 Medicaid (Managed Care)
211 Medicaid HMO
212 Medicaid PPO
213 Medicaid PCCM (Primary Care Case Mgt)
219 Medicaid Managed Care Other
22 Medicaid (Non-managed Care Plan)
23 Medicaid/SCHIP
24 Medicaid Applicant
25 Medicaid - Out of State
29 Medicaid Other
18Third Level Sub-classification
2 MEDICAID
21 Medicaid (Managed Care)
211 Medicaid HMO
212 Medicaid PPO
213 Medicaid PCCM (Primary Care Case Management)
219 Medicaid Managed Care Other
19Additional Level Classification
32 Department of Veterans Affairs
321 Veteran care--Care provided to Veterans
3211 Direct Care--Care provided in VA facilities
3212 Indirect Care--Care provided outside VA facilities
32121 Fee Basis
32122 Foreign Fee/Foreign Medical Program(FMP)
32123 Contract Nursing Home/Community Nrsing Home
32124 State Veterans Home
32125 Sharing Agreements
32126 Other Federal Agency
20Additional Level Classification
8 NO PAYMENT from an Organization / Agency / Program / Private Payer Listed
81 Self Pay
82 No Charge
821 Charity
822 Professional Courtesy
823 Research / Clinical Trial
83 Refusal to Pay / Bad Debt
84 Hill Burton Free Care
85 Research / Donor
89 No Payment, Other
20
21IMPLEMENTATION I Hospital Discharge Data Systems
22States Using the Source of Payment Typology
- Georgia 2007
- Oregon 2008
- New York 2009
23IMPLEMENTATION II Quality eMeasures
24Supplemental Data Elements in eMeasures Include
Payer
- Supplemental data elements are included in
quality emeasures - To aggregate data to various subgroups
- To compare quality across subgroups to identify
disparities
25CMS and National Quality Forum Use Typology as
the Value Set for "Payer"
- CMS 2014 Meaningful Use Clinical Quality Measures
(CQM) require 4 supplemental data sex, race,
ethnicity, payer - NQF Measure Authoring Tool for emeasures includes
"payer" as default supplemental data - National Library of Medicine includes Typology in
Value Set Authority Center for 2014 CQM - Raised the issue of "intellectual property" for
PHDSC Board
26ACTIVITIES OVER THE COMING YEAR
27Maintenance Activities
- Annual maintenance meeting in spring
- opportunity for public comments and requests
- Typology categories and / or definitions updated
every October (as needed) - Periodic Subcommittee conference call discussions
of impact of insurance system changes on needed
payer categories (e.g. from ACA)
28Education/Outreach
- Webinars, conference presentations, emails to
target audiences - e.g., Webinar Nov 19
- Identify take advantage of opportunities that
arise - e.g., this year- PHDSC letter comments on the
proposed Federal rule on the health plan ID
recommended the Typology be included in the CMS
registry for the plan ID
29Questions