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Who do we contact for billing/insurance/medical qu...
# support
o
I mean, questions that pertain to billing/insurance/medical IN Medplum. I am a developer that has never worked as a therapist nor in insurance billing, and neither has anyone at the company. When we have questions such as "how / where should a therapy session note be stored? In a clinicalImpression resource? Something else?", who do we contact? Is this something a therapist themselves would know? Someone that works in insurance billing? Or are these types of questions something that someone at Medplum would be able to answer? Thanks!
r
Have you tried the Medplum Provider app? It will create the notes correctly per the data model. https://www.medplum.com/docs/provider As for therapy billing - maybe @albert_wong has some ideas? That's more domain specific.
a
Good question! Thanks for asking and happy to talk about this. So, there is probably a distinction between progress notes / diagnosis / treatment plan and cpt codes. Which all serve different functions. Progress notes are frequently for therapists to notate and remember things. I think there are a bunch of different options and it might really depend on your use case. Are you wanting to integrate into EPIC and/or an existing mental health care network? If so, finding out what the FHIR structure that the network you are wanting to integrate with uses is probably your best bet for interop. If you are primarily focused on private practice, you have probably more flexibility with options -- I think progress notes are not generally submitted to insurance, except during audits. So there is some flexibilty there and different options to choose from, based on the nature of your provider base. I think more important for insurance is treatment plan, dx, and cpt codes.
o
@reshma @albert_wong thansk for getting back. To explain our use-case a bit more: We are building a therapy telehealth app. It allows patients and therapists to sign up and the backend matches them. In the process of building this out, we will have different questions that none of us would have the answer to because none of is have worked as therapists or in billing. So for example, we can consult with a therapist to ask "what types of notes would a therapist need in order to submit an insruance claim" and the therapist can say "you will want X, y, z", but when when we ask them where in medplum we store these corresponding notes, they dont know, so we dont know who would. Would someone that works in billing know FHIR and where we should store, or do we need to ask people at medplum these questions? as far as "treatment plans, dx, etc", in this stage, we are just trying to incorporate the minimum data collection/storage that is required for a therapist to be able to conduct a session, and for someone at our company to do the insruance claim so the company can get paid, and then we payout the therapist.
yea, even if something isnt submittied to make a claim, but it is required for a therapist to have, we still want to incorporate it, so we just need someone that can explain where we store things in medplum. On the billing end, we can consult with people that do billing like "what data do you need to submit a claim?" and they can give us a concrete list "first name, last name, dob, ssn, etc etc", and likewise we can consult a therapist for things like "what would a therapist need in their portal after a session? Session notes, etc etc", but the missing piece is "who do we ask about what resources we are supposed to store these in, in medplum". We can "guess", and were planning to store session notes as "clinicalImpressions", but the therapist consultant said she didnt think clinicalImpression was correct, but didnt know what resouce IS correct. Can we post the list of questions here, or is there someone you think would know? The list would look like so "we are storing patient name here, is this correct? session note, we dont know where it should be stored, can you point us to where?" etc
as far as the provider app, this MAY work if there is a way to send a provider to it, already logged in (since we have created their medplum accounts with our backend, and they are already authed to us). Is there a way to create an authed url so that they are already authed when they visit?
Looking at the provider app, creating an appt requires a "care template" which the docs say is a "planDefinition". Who would we consult as to how to create a "planDefinition"? A therapist? Would a therapist know what an "identifier" is, whether the "subject" is a "codeableConcept" or "resource" etc? Or is this something only someone familiar with medplum would know?
Or should we just disable "care template" being a required field somehow?
is a care plan / planDefinition something we at the company can create, or is it something that a provider is supposed to be able to create? If the latter, it may be too complicated for the providers. We are only a therapy telehealth and so may only have a finite list of care plans we need to create.
r
PlanDefinitions are FHIR resources. You can create them in the Medplum app. It's recommended to set up a limited number - maybe just one in your case to get started. Here are the intructions: https://www.medplum.com/docs/provider/visits#setting-up-care-templates-via-medplum-app
a
Hmmm... so if you're not worried about interop with a specific other external mental healthcare platform, there's a couple options -- you can check out DocumentReference if they're just writing narrative notes, Composition for more structured session documentation, or DiagnosticReport if there are any assessments/evaluations mixed in. And yeah, patient demo stuff goes in the Patient resource like you'd expect. You could also think about using Questionnaires for structured intakes -- depends on how integrated you want to go with a client portal, etc. but the therapy space has some weird edge cases that don't fit the typical FHIR patterns super cleanly, like treatment plans, progress tracking, outcome measures, so it's smart you're asking before you get too deep into building. And you're welcome to check out my Medplum-based psychotherapy EHR here: www.progressnotes.app . It's a work in progress, but getting pretty close to full-featured -- with some neat automations like progress note templates / transcription and automated treatment plan drafts, etc.
o
@albert_wong the only thing where interop may matter is in our planned STEDI usage (using STEDI within medplum using the bot offering). Thanks for that, Ill pass the suggestions for DocumentReference/Composition/etc along to our therapist consultant, and will take a look at your app.
a
Yes, Stedi has some good documentation, I think -- so you might want to check with the folks over there. But I think they are agnostic regarding Progress Notes, though much more specific regarding Encounter. But let me know what you decide! I'm always curious how folks figure out their way around things and IMHO we should all try to standardize as much as we can! 🙂
k
@oscadev Consider 8x8.com as your telehealth backend, especially when considering data security compliance and a expert vendor which also provides APIs. As to the billing aspect, you are going down a rabbit hole IMO. Like your comms platform, consider choosing a vendor specialized in your task; https://www.availity.com/. Your Medplum distro should focus on keeping clinical data semantics clean and crisp. Good luck w/ your efforts!
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