DAR File No. 40172

Health, Center for Health Data, Health Care Statistics

Rule R428-10

Health Data Authority Hospital Inpatient Reporting Rule

Notice of Proposed Rule

(Repeal and Reenact)

DAR File No.: 40172
Filed: 01/29/2016 12:37:02 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

This amendment is in response to a review of both Rules R428-10 and R428-11 that identified both rules, for purposes of better consistency and clarity of existing practice, could be consolidated into one administrative rule. (DAR NOTE: The proposed repeal of Rule R428-11 is under DAR No. 40173 in this issue, February 15, 2016, of the Bulletin.)

Summary of the rule or change:

The proposed repeal and reenactment changes the rule title to accurately reflect consolidation of Rules R428-10 and R428-11 into the new Rule R428-10; updates definitions in rule purpose; clarifies rule purpose and also data reporting requirements by healthcare facilities; and makes technical and conforming amendments.

State statutory or constitutional authorization for this rule:

• Title 26, Chapter 33a

Anticipated cost or savings to:

the state budget:

This amendment reflects the consolidation of Rules R428-10 and R428-11 that improves consistency and clarity of the new Rule R428-10. The Utah Department of Health (UDOH) determines that these changes will not create any cost or savings impact to the state budget or UDOH's budget, since the changes will not increase workload and can be carried out with existing budget.

local governments:

This filing does not create any direct cost or savings impact to local governments since they are not directly affected by the rule nor are local governments indirectly impacted because the rule does not create a situation requiring services from local governments.

small businesses:

None--Small businesses will not be impacted by this rule change. As a result, the rule will have no effect on small business budgets for costs or savings.

persons other than small businesses, businesses, or local governmental entities:

Consolidation of Rules R428-10 and R428-11 into a new Rule R428-10 that includes a few technical changes will not create any cost or savings to businesses, individuals, local governments, or persons that are not small businesses.

Compliance costs for affected persons:

There are no compliance costs for persons affected by these changes to Rule R428-10. Although there are several modifications within this amendment, they will not impact affected persons.

Comments by the department head on the fiscal impact the rule may have on businesses:

There is no fiscal impact on business because there were no substantive changes to the requirements and the technical changes do not add compliance costs to affected businesses.

Joseph Miner, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Center for Health Data, Health Care Statistics
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Mike Martin at the above address, by phone at 801-538-9205, by FAX at 801-538-9916, or by Internet E-mail at [email protected]
• Stephanie Saperstein at the above address, by phone at 801-538-6430, by FAX at , or by Internet E-mail at [email protected]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

03/16/2016

This rule may become effective on:

03/23/2016

Authorized by:

Joseph Miner, Executive Director

R428. Health, Center for Health Data, Health Care Statistics.

[R428-10. Health Data Authority Hospital Inpatient Reporting Rule.

R428-10-1. Legal Authority.

This rule is promulgated under authority granted by Title 26, Chapter 33a, and in accordance with the Health Data Plan.

 

R428-10-2. Purpose.

This rule establishes the reporting standards for inpatient discharge data by licensed hospitals. The data will be used to develop and maintain a statewide hospital discharge data base.

 

R428-10-3. Source of Inpatient Hospital Discharge Data.

(1) The source for hospital inpatient discharge data shall be Utah licensed hospitals.

(2) Each hospital shall report discharge data records for each inpatient discharged from its facility.

(3) For a patient with multiple discharges, each hospital shall submit a single discharge data record for each discharge. For a patient with multiple billing claims each hospital shall consolidate the multiple billings into a single discharge data record for submission after the patient's discharge.

(4) A hospital may designate an intermediary or may submit discharge data directly to the committee.

(5) Each hospital is responsible for compliance with these rules. Use of a designated intermediary does not relieve the hospital of its reporting responsibility.

(6) Each hospital shall designate a department or other appropriate entity within the hospital and a person responsible for submitting the discharge data records. This person shall also be responsible for communicating with the Office.

(7) The Department of Health may conduct on-site audits to verify the accuracy of all submittals.

 

R428-10-4. Data Submittal Schedule.

Each hospital shall submit to the Office discharge data according to the schedule shown in Table 1. The Director of the Office may approve an alternate schedule that meets the needs of the committee.

 

TABLE

(1) HOSPITAL DISCHARGE DATA SUBMITTAL SCHEDULE

 

PATIENT'S DATE OF DISCHARGE DISCHARGE DATA RECORD
  
IS BETWEEN IS DUE BY
  
January 1 through March 31 May 15
  
April 1 through June 30 August 15
  
July 1 through September 30 November 15
  
October 1 through December 31 February 15

 

R428-10-5. Data Element Reporting.

(1) Tables 2 and 3 list the required data elements. Each hospital shall collect and report all data elements shown in Table 2. Each hospital shall report data elements shown in Table 3 whenever the information is a part of the hospital's patient record. Hospitals shall base data submissions on the specifications in the Submittal Manual for Inpatient Data.

(2) Each hospital shall collect patient social security number as a required data element on the hospital discharge record and report the patient social security number with the complete discharge record according to the submittal schedule.

(3) The Office shall adopt an encryption method for the patient social security number by creating a record linkage number as the control number.

(4) Each hospital shall submit the reported data elements on encrypted electronic media acceptable to the Office or send electronically through the Utah Health Information Network or another compatible electronic data interchange network or other secure upload or secure email method.

(5) The Office shall accept data that complies with data standards established in Rule R590-164, Uniform Health Billing Rule.

 

TABLE

(2) LEVEL 1 DATA ELEMENTS

 

CATEGORY NAME
  
 Provider
  

  
 1. Provider identifier (hospital name)
  
 Patient
  
 2. Patient control number
  
 3. Patient's medical record number
  
 4. Patient Social Security Number
  
 5. Patient name
  
 6. Patient's address, city, state, zip
  
 7. Patient's date of birth
  
 8. Patient's gender
  
 Service
  
 9. Admission date
  
 10. Type of admission/visit
  
 11. Point of origin for admission or visit
  
 12. Patient's discharge status
  
 13. Statement covers period
  
 14. Condition codes (do not resuscitate,
  
 homeless, others)
  
 Charge
  
 15. Service line
  
 16. Revenue codes
  
 17. HCPCS Procedure codes including modifiers
  
 18. Unit or basis for measurement code
  
 19. Service units/days
  
 20. Total charges by revenue code
  
 Payer
  
 21. Payer's identification
  
 22. Patient's relationship to insured
  
 Diagnosis and Treatment
  
 23. Diagnosis version qualifier
  
 24. Principal diagnosis with present on
  
 admission
  
 25. Other diagnosis codes with present on
  
 admission
  
 26. Admitting diagnosis code
  
 27. Patient's reason for visit codes
  
 28. External cause of injury codes (E-code)
  
 with present on admission
  
 29. Principal ICD procedure code
  
 30. Other ICD procedure codes
  
 31. Date of principal procedure
  
 Physician
  
 32. Attending provider primary ID
  
 33. Operating physician primary ID
  
 34. Other operating physician primary ID
  
 35. Rendering physician primary ID
  
 36. Referring provider primary ID
  
 Other
  
 37. Type of bill

 

TABLE

(3) LEVEL 2 DATA ELEMENTS

 

CATEGORY NAME
  
 Patient
  
 1. Patient marital status
  
 2. Patient race and ethnicity
  
 Employer
  
 3. Employer name
  
 Charge
  
 4. Prior payments
  
 5. Estimated amount due
  
 Payer
  
 6. Insured names
  
 7. Certificate/Social Security Number/Health
  
 Insurance Claim/Identification Number
  
 8. Insured group names
  
 Physician
  
 9. Attending provider secondary ID
  
 10. Attending provider specialty information
  
 11. Operating physician secondary ID
  
 12. Operating physician specialty information
  
 13. Other operating physician secondary ID
  
 14. Other operating physic. specialty
  
 information
  
 15. Rendering physician secondary ID
  
 16. Rendering physician specialty information
  
 17. Referring provider secondary ID
  
 18. Referring provider specialty information
  
 19. Resident ID
  
 20. Resident ID Type]

 

R428-10. Health Data Authority Healthcare Facility Data Reporting Rule.

R428-10-1. Legal Authority.

This rule is promulgated under authority granted by Title 26, Chapter 33a and in accordance with the Utah Health Data Plan as adopted in section R428-1.

 

R428-10-2. Purpose.

This rule establishes requirements for healthcare facilities to submit data to the Utah Department of Health.

 

R428-10-3. Coordination of Rules.

The Office will use data collected in this section to develop and maintain a statewide Healthcare Facility Database. Upon receipt of emergency room data, the Office shall provide a copy of the emergency room data to the Bureau of Emergency Medical Services and Preparedness for use as described in R426.

 

R428-10-4. Data Reporting.

(1) Healthcare facilities shall submit ambulatory surgery data to the Office. In addition, hospitals shall submit discharge data and emergency data to the Office.

(2) Healthcare facilities shall submit healthcare facility data to the Office in accordance with the Utah Healthcare Facility Data Submission Guide.

(3) Healthcare facilities shall submit data for all fields required in this section if the data are available. Healthcare facilities shall notify the Office or its designee of any data elements or fields required to be reported under this rule, but are not available to the healthcare facility.

(4)(a) Healthcare facilities shall submit healthcare facility data to the Office or its designee according to the schedule in the Utah Healthcare Facility Data Submission Guide.

(b) The Director of the Office may approve an alternate submission date as long as it meets the needs of the committee.

(5) Healthcare facilities shall submit healthcare facility data by a secure method according to the Utah Healthcare Facility Data Submission Guide.

(6) The Office or its designee may conduct on-site audits to verify the accuracy and completeness of all submittals.

 

KEY: health, health data, hospital policy, health planning

Date of Enactment or Last Substantive Amendment: [August 5, 2014]2016

Notice of Continuation: November 30, 2011

Authorizing, and Implemented or Interpreted Law: 26-33a-104; 26-33a-108