Cost_type_concept_id for patient payment

[Alexandra_Orlova]

Hi all!
If I want to add record with patient payment what cost_type_concept_id value should I choose?
I see 3 standard concept_ids:
31968 - Payer is primary (coordination of benefit)
31969 - Payer is secondary (coordination of benefit)
31970 - Premium
So I have to choose 31969 for patient payment if part of the bill amount has to be paid by insurance company and I have to choose 31968 if only patient has to pay the bill. Is it correct?

For example:
Case 1:
Total bill: $100
Insurance company1: $70
Insurance company2: $20
Patient: $10
For patient payment choose 31969 - Payer is secondary (coordination of benefit)

Case 2:
Total bill: $15
Patient: $15
For patient payment choose 31968 - Payer is primary (coordination of benefit)

Thank you in advance

[Gowtham_Rao]

Good morning. Thank you for the question.

Have you seen the new approved cost table? This is expected to be officially released in October 2018 as part of CDM 6.0. Please see details here https://github.com/OHDSI/CommonDataModel/tree/Dev?files=1 it has two key fields cost_concept_id and cost_type_concept_id. The later is for the provenance. This is a long table, i.e. each cost has it’s own row record.

The current omop vocabulary is designed to support this unreleased version of CDM cost table.

If the cost record is to be linked to payer_plan_period, the current recommendation is to use either 31968 or 31969 or 31970 from here http://athena.ohdsi.org/search-terms/terms?domain=Type+Concept&vocabulary=Cost+Type&page=1&pageSize=15&query= in your use case above, if the patient has insurance and that information is in payer_plan_period , then depending on whether that insurance was primary or secondary - I would use either 31968 or 31969 for all rows corresponding to the insurance company, depending on whether it is primary or secondary.

If the cost record has no relation to payer_plan_period table e.g. uninsured/self pay - then we currently don’t have standard cost type concepts. We will have to create some. Coat_type_concept_id is a required field.

Note: the new cost table has cost_concept_id that can represent a lot of different costs. http://athena.ohdsi.org/search-terms/terms?domain=Cost&vocabulary=Cost&standardConcept=Standard&page=1&pageSize=50&query=

[Alexandra_Orlova]

Thank you for very quick answer!

[Alexandra_Orlova]

So we need to add a new concept for patient payment. Am I right?

If yes, can such a concept be created?

[Alexandra_Orlova]

Up
Colleagues, could you please create a new concept_id for patient payment?

@Gowtham_Rao @Dymshyts @Christian_Reich

[Gowtham_Rao]

@Alexandra_Orlova do you know what type of patient payment. There are quite a few concepts here

In USA the concepts for patient payments are Copayment, Coinsurance, Deductible, Patient Liability etc.

We some pending requests here

[Alexandra_Orlova]

@Gowtham_Rao thank you for response
I’ll try to figure it out. But not sure that I will have info about type of patient payment.
About link to Athena - these concepts have domain = Cost and vocabulary = Cost, but I thought that we should use domain = Type Concept and vocabulary = Cost Type for field cost_type_concept_id

[Gowtham_Rao]

Good question. We changed the cost table into a long form, because we wanted concept-id to manage the meaning of the cost.

OHDSI/CommonDataModel

This new form will be available in cdm 6.0

In omop CDM, type-concepts is used to represent provenance of the data e.g. is the cost information coming from billing system, or reimbursement system, or primary payer, secondary payer.

We have these cost-type

http://athena.ohdsi.org/search-terms/terms?domain=Type+Concept&conceptClass=Type+Concept&page=1&pageSize=15&query=

[Alexandra_Orlova]

@Gowtham_Rao got it, thank you.

1. So if I understood correctly cost-types should be updated with billing system and reimbursement system. Is that correct?
2. Do you know the meaning of ‘Premium’ cost type?
3. We do not have new version of cost table for now. We have only cost_type_concept_id field and do not have cost_concept_id field. And we have to populate table somehow. So for example, I have payment from primary payer, payment from secondary payer and payment from patient for one claim. Should I create 3 records for this case?
   For example:
   source data:
   
   

cdm.cost:

cdm.payer_plan_period:

Is that correct? And if yes, then what cost_type_concept_id should I use for third record in cost table (patient payment)?

[Gowtham_Rao]

@Alexandra_Orlova

So if I understood correctly cost-types should be updated with billing system and reimbursement system. Is that correct?

Yes, or other types of financial source systems

@Alexandra_Orlova

2. Do you know the meaning of ‘Premium’ cost type?

this is cost that the insurance company would collect from the contract holder for coverage. The cost_event_id would be payer_plan_period_id of the payer_plan_period table here

Note: cost_domain_id will be deprecated in CDM 6.x because we dont like ‘text’ and would like to use integer (i.e. concept_id). We will most probably have a concept_id for each CDM table, and that will be used.

We also have the construct of detail cost vs summary cost concepts. If the cost is a component/detail/line level then use line level concept

[Alexandra_Orlova]

@Gowtham_Rao thank you for the example and the explanation
I understood updates for cost table in CDM 6.x But I have to populate cost table for CDM 5.3
And I still do not understand what value for cost_type_concept_id should I use for patient payment? (Third line in my example - $4) .
Do you have an idea about that?

[Gowtham_Rao]

payment from patient for one claim.

I think this would be a separate cost column in v5.3; something like paid_by_patient

[jenniferduryea (Jen Duryea)]

Hi @Alexandra_Orlova. What data source are you working with to convert cost data to OMOP?

Unfortunately, you are in the middle of a big change to the COST table, between version CDM 5.3 and CDM 6.0. Unfortunately we have a disparity here. The CDM you are working on is CDM 5.3 but the current vocabulary files are written for CDM 6.0. And so you are trying to add cost_type_concept_id for CDM 6.0 into CDM 5.3. And it’s not going to work - or it will be very messy.

The cost_type_concept_id in CDM 5.3 should denote that the data comes from a billing accounting system, a claims database, or whatever data set you are looking at. I’m assuming all three payments ($20, $6, $4 in the above example) all come from looking at the same data source? If all three of those costs come from the same data source, then all three payments need to reference the same cost_type_concept_id. My only suggestion is to pick a cost_type_concept_id and apply it across the board. Then make a note that because you are using the most updated vocabulary, you are using this type_concept_id to stay compliant, but in analysis, it means “xyz”.

@Gowtham_Rao it looks like you requested to remove or change these type_concept_ids in a request. I didn’t think it was that big of a deal because I didn’t think anyone was using the CDM 5.3 Cost table. But it seems that there are more users than you and me So we may want to add in some cost_type_concept_ids that are CDM 5.3 compliant.

[Alexandra_Orlova]

@jenniferduryea thank you!
I am working with Dx and Rx claims. For Dx claims there is only one charge field related to the services, but for Rx claims there are a lot of fields including amounts charged to the primary / secondary plan in the encounter and amount paid by the patient at the register after any coordination of benefits buy down.