EHRS-FM IG

ISO/HL7 10781 - Electronic Health Record System Functional Model, Release 2.1
0.16.0 - CI Build

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Requirements: AS.8.2 Support Rules-Driven Financial & Administrative Coding (Function)

Active as of 2024-08-12
Statement N:

Provide financial and administrative coding assistance based on the structured data and unstructured text available in the encounter documentation.

 Description I:

The user is assisted in coding information for billing or administrative reasons. For example, in the US Domain, the HIPAA 837 Professional claim requires the date of the last menstrual cycle for claims involving pregnancy. To support the generation of this transaction, the provider would need to be prompted to enter this date when the patient is first determined to be pregnant, then making this information available for the billing process.

 Criteria N:
AS.8.2#01 SHALL

The system SHALL provide the ability to maintain and render financial and administrative codes.
AS.8.2#02 SHOULD

The system SHOULD provide the ability to extract data from the electronic health record as required to simplify the coding of financial and administrative documentation.
AS.8.2#03 MAY

The system MAY render rules-driven prompts to facilitate the collection of data in the clinical workflow that is required for administrative and financial coding.
AS.8.2#04 MAY

The system MAY provide the ability to determine coding required for administrative and financial documents based on provider specialty, care setting and other information that may be entered into the system during the encounter.
AS.8.2#05 MAY

The system MAY determine (e.g., internally generate) administrative and financial coding (e.g., place of service, type of facility, or tax rates).
AS.8.2#06 SHOULD

The system SHOULD provide the ability to render notification to appropriate user(s) about coding-related documentation deficiencies.
AS.8.2#07 MAY

The system MAY provide the ability to render highlighting of coding-related documentation deficiencies.