ISO/HL7 10781 - Electronic Health Record System Functional Model, Release 2.1
0.16.0 - CI Build
ISO/HL7 10781 - Electronic Health Record System Functional Model, Release 2.1
0.16.0 - CI Build
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| Active as of 2024-08-12 |
<Requirements xmlns="http://hl7.org/fhir">
<id value="EHRSFMR2.1-AS.8.2"/>
<meta>
<profile value="http://hl7.org/ehrs/StructureDefinition/FMFunction"/>
</meta>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml">
<span id="description"><b>Statement <a href="https://hl7.org/fhir/versions.html#std-process" title="Normative Content" class="normative-flag">N</a>:</b> <div><p>Provide financial and administrative coding assistance based on the structured data and unstructured text available in the encounter documentation.</p>
</div></span>
<span id="purpose"><b>Description <a href="https://hl7.org/fhir/versions.html#std-process" title="Informative Content" class="informative-flag">I</a>:</b> <div><p>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.</p>
</div></span>
<span id="requirements"><b>Criteria <a href="https://hl7.org/fhir/versions.html#std-process" title="Normative Content" class="normative-flag">N</a>:</b></span>
<table id="statements" class="grid dict">
<tr>
<td style="padding-left: 4px;">
<span>AS.8.2#01</span>
</td>
<td style="padding-left: 4px;">
<span>SHALL</span>
</td>
<td style="padding-left: 4px;" class="requirement">
<span><div><p>The system SHALL provide the ability to maintain and render financial and administrative codes.</p>
</div></span>
</td>
</tr>
<tr>
<td style="padding-left: 4px;">
<span>AS.8.2#02</span>
</td>
<td style="padding-left: 4px;">
<span>SHOULD</span>
</td>
<td style="padding-left: 4px;" class="requirement">
<span><div><p>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.</p>
</div></span>
</td>
</tr>
<tr>
<td style="padding-left: 4px;">
<span>AS.8.2#03</span>
</td>
<td style="padding-left: 4px;">
<span>MAY</span>
</td>
<td style="padding-left: 4px;" class="requirement">
<span><div><p>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.</p>
</div></span>
</td>
</tr>
<tr>
<td style="padding-left: 4px;">
<span>AS.8.2#04</span>
</td>
<td style="padding-left: 4px;">
<span>MAY</span>
</td>
<td style="padding-left: 4px;" class="requirement">
<span><div><p>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.</p>
</div></span>
</td>
</tr>
<tr>
<td style="padding-left: 4px;">
<span>AS.8.2#05</span>
</td>
<td style="padding-left: 4px;">
<span>MAY</span>
</td>
<td style="padding-left: 4px;" class="requirement">
<span><div><p>The system MAY determine (e.g., internally generate) administrative and financial coding (e.g., place of service, type of facility, or tax rates).</p>
</div></span>
</td>
</tr>
<tr>
<td style="padding-left: 4px;">
<span>AS.8.2#06</span>
</td>
<td style="padding-left: 4px;">
<span>SHOULD</span>
</td>
<td style="padding-left: 4px;" class="requirement">
<span><div><p>The system SHOULD provide the ability to render notification to appropriate user(s) about coding-related documentation deficiencies.</p>
</div></span>
</td>
</tr>
<tr>
<td style="padding-left: 4px;">
<span>AS.8.2#07</span>
</td>
<td style="padding-left: 4px;">
<span>MAY</span>
</td>
<td style="padding-left: 4px;" class="requirement">
<span><div><p>The system MAY provide the ability to render highlighting of coding-related documentation deficiencies.</p>
</div></span>
</td>
</tr>
</table>
</div>
</text>
<url value="http://hl7.org/ehrs/Requirements/EHRSFMR2.1-AS.8.2"/>
<version value="0.16.0"/>
<name
value="AS_8_2_Support_Rules_Driven_Financial___Administrative_Coding"/>
<title
value="AS.8.2 Support Rules-Driven Financial & Administrative Coding (Function)"/>
<status value="active"/>
<date value="2024-08-12T10:56:01+00:00"/>
<publisher value="EHR WG"/>
<contact>
<telecom>
<system value="url"/>
<value value="http://www.hl7.org/Special/committees/ehr"/>
</telecom>
</contact>
<description
value="Provide financial and administrative coding assistance based on the structured data and unstructured text available in the encounter documentation."/>
<purpose
value="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."/>
<statement>
<extension
url="http://hl7.org/ehrs/StructureDefinition/requirements-dependent">
<valueBoolean value="false"/>
</extension>
<key value="EHRSFMR2.1-AS.8.2-01"/>
<label value="AS.8.2#01"/>
<conformance value="SHALL"/>
<conditionality value="false"/>
<requirement
value="The system SHALL provide the ability to maintain and render financial and administrative codes."/>
<derivedFrom value="EHR-S_FM_R1.1 S.3.2.2#1"/>
</statement>
<statement>
<extension
url="http://hl7.org/ehrs/StructureDefinition/requirements-dependent">
<valueBoolean value="false"/>
</extension>
<key value="EHRSFMR2.1-AS.8.2-02"/>
<label value="AS.8.2#02"/>
<conformance value="SHOULD"/>
<conditionality value="false"/>
<requirement
value="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."/>
<derivedFrom value="EHR-S_FM_R1.1 S.3.2.2#2"/>
</statement>
<statement>
<extension
url="http://hl7.org/ehrs/StructureDefinition/requirements-dependent">
<valueBoolean value="false"/>
</extension>
<key value="EHRSFMR2.1-AS.8.2-03"/>
<label value="AS.8.2#03"/>
<conformance value="MAY"/>
<conditionality value="false"/>
<requirement
value="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."/>
<derivedFrom value="EHR-S_FM_R1.1 S.3.2.2#3"/>
</statement>
<statement>
<extension
url="http://hl7.org/ehrs/StructureDefinition/requirements-dependent">
<valueBoolean value="false"/>
</extension>
<key value="EHRSFMR2.1-AS.8.2-04"/>
<label value="AS.8.2#04"/>
<conformance value="MAY"/>
<conditionality value="false"/>
<requirement
value="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."/>
<derivedFrom value="EHR-S_FM_R1.1 S.3.2.2#4"/>
</statement>
<statement>
<extension
url="http://hl7.org/ehrs/StructureDefinition/requirements-dependent">
<valueBoolean value="false"/>
</extension>
<key value="EHRSFMR2.1-AS.8.2-05"/>
<label value="AS.8.2#05"/>
<conformance value="MAY"/>
<conditionality value="false"/>
<requirement
value="The system MAY determine (e.g., internally generate) administrative and financial coding (e.g., place of service, type of facility, or tax rates)."/>
<derivedFrom value="EHR-S_FM_R1.1 S.3.2.2#5"/>
</statement>
<statement>
<extension
url="http://hl7.org/ehrs/StructureDefinition/requirements-dependent">
<valueBoolean value="false"/>
</extension>
<key value="EHRSFMR2.1-AS.8.2-06"/>
<label value="AS.8.2#06"/>
<conformance value="SHOULD"/>
<conditionality value="false"/>
<requirement
value="The system SHOULD provide the ability to render notification to appropriate user(s) about coding-related documentation deficiencies."/>
</statement>
<statement>
<extension
url="http://hl7.org/ehrs/StructureDefinition/requirements-dependent">
<valueBoolean value="false"/>
</extension>
<key value="EHRSFMR2.1-AS.8.2-07"/>
<label value="AS.8.2#07"/>
<conformance value="MAY"/>
<conditionality value="false"/>
<requirement
value="The system MAY provide the ability to render highlighting of coding-related documentation deficiencies."/>
</statement>
</Requirements>