HIDI change for Q1 08 discharge data submission - April 8, 2008
Effective with discharge data for January - March 2008 (Q1 08), when HIDI sends you an email notifying you that your quarterly data has been processed and your reports are ready to be viewed, they will attach a report that shows your inpatient and outpatient error summary pages (see this example). These pages are just the "summary" pages, so they do not include any PHI. These reports will also show any Fatal error messages with a rate above 2% in red print. You will need to address these errors to bring your Fatal error rate to no more than 2%.
I have also asked HIDI to use blue print to flag Warnings with a rate more than 2% IF the Warning error will become a Fatal error when the July 2008 or January 2009 discharges are submitted. These Warning errors that are becoming Fatal errors are the ones you need to address now before they cause problems for your data submission. (Warning errors that will remain as Warnings will be in black print if the rate is more than 2% -- only those that will become Fatal errors soon will be in blue.)
If you have any questions, feel free to contact Jean Young at 615.401.7429
Payer Codes added in 2007 - March 3, 2008
I would like to remind everyone that in 2007 we added some new payer codes that should be used (if appropriate) in reporting the hospital discharge data.
The payer codes added in 2007 are as follows:
10 = Amerigroup Community Care (new TennCare MCO effective Apr 1, 2007)
11 = Cover TN (also known as the Blue Cross InReach plan; Blue Cross Network V)
12 = Cover Kids
13 = Access TN
It is extremely important that hospitals use the new MCO code (code 10) and the new Cover Tennessee codes (11, 12, and 13 above) when reporting discharges that have these types of coverage. THA will use the data to carefully monitor the operations of the plans in order to identify issues with the coverage that are negatively impacting hospitals and to substantiate the need for plan changes.
Importance of reporting correct NPI in UB-04 discharge record - February 28, 2008
The Tennessee law and associated rules and regulations that require hospitals to submit discharge data to the TN Dept of Health require all inpatient discharges and selected outpatient discharges to be reported. Reporting on the inpatient side includes discharges from psych and rehab units within an acute care facility as well as the acute care inpatient discharges.
The new UB-04 format requires the hospital's NPI be reported in positions 1497-1511 in each 2538-character record that is submitted. It is very important that the NPI reported in each record accurately reflect the NPI for the unit where the patient was treated. If your hospital has a psych unit or a rehab unit and these units have an NPI that is different from the acute care NPI, the discharges from these units should report the appropriate NPI for the unit where the patient was treated (psych patients would report the psych NPI; rehab patients would report the rehab NPI, etc.). Most hospitals will have a NPI for the acute care setting and different NPIs for the psych and/or rehab units.
This correct NPI reporting by unit will allow the patients seen for psych and/or rehab services to be easily excluded from some data projects where only the acute care patients should be included. This will also allow for improved analysis for services provided in these specific units because the discharges can easily be identified by the NPI reported in the record.
Some hospitals will also have different NPIs for other units such as swing beds, SNF, hospice, and home health. These types of discharges are not included in the state’s hospital discharge reporting requirement.
Please work with your IT staff or your vendor to ensure that the NPI that is being reported in each of your discharge records is accurate for the type of discharge being submitted.
Patient Discharge Status Code Changes - February 5, 2008
Code 05 – code definition changed to “Discharged/transferred to a Designated Cancer Center or Children’s Hospital”
Usage Note: Transfers to non-designated cancer hospitals should use Code 02. A list of National Cancer Institute Designated Cancer Centers can be found at http://cancercenters.cancer.gov
Code 70 – new code added; definition “Discharged/transferred to another Type of Health Care Institution not Defined Elsewhere in this Code List”
The implementation of these codes was delayed from October 1, 2007 discharges until April 1, 2008 discharges.
Moving to MSDRGs - February 1, 2008
This document explains how THA plans to handle the move from DRGs to MS-DRGs effective with October 1, 2007 inpatient discharges. As you know the DRG and MS-DRG groupings are very different. Since THA MarketIQ provides some trend reports what will be affected by this change, THA needed to develop a process for handling the change in THA MarketIQ. This process can also be used for trend-type analysis using the THA HIN databases. This plan has been approved recently by the THA Data Policy Committee.
This change will not affect the data on THA MarketIQ or in the THA HIN inpatient database until the Oct-Dec 2007 discharges are added. The target date for adding these discharges is mid-late May 2008. Until that time, the DRGs and THA DRG product lines will continue to be used. The new MS-DRGs and MS-DRG product lines assignments available here.
DELAY on new fatal edit related to CPTs and ICD9 procedure codes - January 16, 2008
THA has asked the Department of Health and HIDI to DELAY the implementation of the new fatal edit related to CPTs and ICD9 procedure codes. This edit would require an ICD9 procedure code in principal procedure if there was one or more CPT codes reported in the range 10021-69990 (ambulatory surgery). The problem with this edit is that there are CPT codes within the CPT range that have no corresponding ICD9 procedure code, or the corresponding ICD9 procedure code is outside the ICD9 range used to define the ambulatory surgery records (00.01-86.99). Until further notice, this edit will NOT be used on the discharge data.
Reporting Clarification Letter from HDDS - January 11, 2008
This letter was mailed out by the Tennessee Department of Health today clarifying some additional UB-04 reporting issues. You should receive an official copy of this letter in the mail.
Penalty Enforcement Letter from HDDS - November 2, 2007
HDDS sent out this letter today with information regarding the commencement of penalty enforcement for excessive reporting errors.
UB-04 Clarification Letter from HDDS - October 31, 2007
HDDS sent out this letter today with some clarification regarding UB-04 Claims Data Reporting
Point of Origin Codes - October 18, 2007
Effective October 1, 2007, UB-04 field locator 15 has been renamed: Point of Origin for Admission or Visit. Click here for information regarding the changes to the field previously known as Source of Admission. Field values 3 and A and Newborn values 1-4 have been discontinued.
Apparently these changes caught a lot of hospitals and payers unprepared but according to the latest information I have been able to gather, the new codes are in effect now.
Differences in CMS and TDH requirements for POA information - September 06, 2007
It is our understanding that there are differences in Present on Admission (POA) requirements between what CMS is requiring and what the Tennessee Department of Health (TDH) State Discharge Reporting System is requiring. These differences are itemized below:
1. EFFECTIVE DATE:
- CMS is requiring POA information to be reported effective with October 1, 2007 discharges.
- TDH is requiring POA information to be reported in the hospital discharge data effective with January 1, 2008 discharge information. TDH decided to allow an additional quarter for hospitals to become more familiar with the national guidelines before the POA data is edited in the hospital discharge information. Hospitals may submit POA information in the October -December 2007 data submission but the data will not be edited for absence/presence or validity of POA information until the January 1, 2008 discharge data is received.
2. HOSPITALS REQUIRED TO REPORT POA:
- CMS is only requiring POA information to be reported for inpatient discharges from acute care hospitals. CMS does not require POA information to be reported by critical access hospitals, cancer hospitals, LTCH, pediatric hospitals, psychiatric hospitals or rehabilitation hospitals.
- TDH is requiring POA information to be reported by ALL hospitals that are required to report discharge data to the Department. This includes hospitals excluded by the CMS requirement. The POA information will be used to help assess patient safety and address quality of care and performance measurement so this information is needed from all inpatient discharges from all Tennessee hospitals.
New UB-04 Edits - August 28, 2007
As you know there are several new fields being required when we move to the new UB-04 format for discharges occurring on or after July 1, 2007. Whenever new fields are added to the required dataset, new edits are also added to the processing to ensure that the data being captured is of highest quality.
Please download this file.
The document shows the new edits that were applied to the October 2006 discharges when the formats for the 3 provider fields (Attending physician, Other physician 1, and Other physician 2) were changed. The document also shows the new NPI validity edit that was added for the January 2007 discharge data.
This document also lists the new edits that will be applied to the July 1, 2007 discharges and to the January 1, 2008 discharges. THA recently met with the Department of Health staff and the Department has agreed to make most but not all of these new field edits Warnings for at least the first year. After the first year, some of these Warnings may become Fatal edits depending on the decisions made by the Department. Because of this, each hospital should be aware of the volume of the errors in these new fields and if the volume is high, the hospital should address the problem before these edits become Fatal errors.
UB-04 Discharge Data Issues to be Aware Of... - July 17, 2007
PRINCIPAL PROCEDURE on outpatient records.
The principal procedure and principal procedure date STILL MUST be provided as an ICD-9 procedure code on all outpatient records if there was a procedure provided. This principal procedure code should be provided in positions 1856-1862 and the corresponding procedure date should be provided in positions 1863-1870 of the new 2538 position record.
CPTs and HCPCS codes from Form Locator 44 should also be reported beginning with the data submitted in UB-04 format (discharges on or after July 2007).
TYPE ED VISIT and OUTCOME ED VISIT
If a hospital does not screen the patients coming through their ED (all patients who present to the ED are treated regardless of their medical condition or ability to pay), the correct response to Type of ED visit and Outcome of ED visit is '99' in positions 2070-2071. There are hospitals in Tennessee that are screening ED patients and these questions are to provide some information from those hospitals and to see how many patients are being referred to other sources of care because their medical condition does not warrant emergency room services.
Every ED record (records with revenue code 045X in any revenue code field) must have a code in positions 2070 and 2071. Position 2070 may be codes 1-3, or 9 and position 2071 may be codes 1-4, or 9. If there is no revenue code 045X in the record, positions 2070-2071 should be left blank.
Requirement to report Joint Annual Report (JAR) ID number on all discharge records - May 11, 2007
HDDS has sent out this letter regarding a new requirement to report Joint Annual Report (JAR) ID number on all discharge records.
Invalid TN License Numbers - May 07, 2007
1. Be aware that a new fatal edit has been added for the 1st quarter 2007 UB data. This edit checks the Attending physician, Other physician 1, and Other physician 2 NPI if reported. Using the Luhn algorithm, this edit indicates if the number reported is a valid NPI. If the NPI reported is not considered valid according to the Luhn algorithm, it will be considered a fatal error.
2. The Tennessee profession code indicator (MD, DO, NP, DS, etc.) and 10-digit Tennessee state license number should be provided for all provider fields if applicable. Facilities that overuse the unknown code for this information will eventually have fatal edit problems if these license numbers are not provided. This profession code-license number information will be used to supply the provider name since there is no crosswalk currently available for the NPI so it is very important that every facility report the profession code and license numbers for their providers.
3. Please DO NOT submit discharge data in the new UB-04 format for the Q1 07, January - March 2007, discharges. The new format may be used for submitting the Q2 07 discharges (since May 23 falls in Q2) but it is preferred that the new format not be used until you submit the Q3 07 data. The Q3 07 data is due to be submitted by November 29, 2007.
Fatal Error Rate - Dropped to 2% - April 30, 2007
The fatal error rates allowed for 2007 discharge data are dropping to no more than 2% for inpatient data and no more than 2% for outpatient data.
Prior to 2007 discharges, the fatal error rate was required to be no more than 3% for the inpatient and outpatient data.
UB-04 Layout Clarification - April 27, 2007
To clarify some information in the new UB-04 Hospital Discharge Data System Manual, Fields 259-265 should be left blank by hospitals. These fields occupy positions 2072-2298 in the new UB-04 record layout.
The patient street address, patient name, and insured's name fields, Fields 266-274, occupy positions 2299-2538 of the new UB-04 record layout. These fields should be reported by hospitals for all discharges when the data is submitted to HIDI. However, when HIDI creates the files that are provided to the TN Dept of Health (TDH), the street address and a small portion (initials) of the name fields will be provided to TDH only for selected records. For records that do not meet the selected record criteria, the street address and name fields will be deleted from the HIDI master files and not provided to any entity. The Dept is hoping they can use these fields to improve their ability to link discharge data with data in other public health related databases. They are willing to try the initials only for this linkage. If using initials only doesn't improve the linkage rate, the Dept will probably require HIDI to supply the entire names -- but only for these selected records (birth defects and crash outcomes records). Hospitals will be notified in advance if the data submitted to the Dept is expanded from the initials only to the full name fields.
Patient Relationship to Insured Code Changes - April 26, 2007
I recently became aware that the codes used by the “Patient Relationship to Insured” fields have changed again effective with March 1, 2007 discharges. The codes for these fields are established by a national billing committee and Tennessee adopts these national codes. The new Patient Relationship to Insured codes are a limited subset of the codes currently used for these fields.
The new codes to be used in the three (3) Patient Relationship to Insured fields (primary, secondary, and tertiary) are as follows:
01 = Spouse
18 = Self
19 = Child
20 = Employee
21 = Unknown
39 = Organ Donor
40 = Cadaver Donor
53 = Life Partner
G8 = Other Relationship
When HIDI edits the UB data submitted by each hospital, they edit these fields for valid codes. Even though these new codes are effective with March 1, 2007 discharges, HIDI will not flag records that contain the old codes that are no longer in use until the 2nd quarter 2007 discharge data (discharges occurring on or after April 1, 2007) is processed. Any records submitted for the 1st quarter 2007 will be accepted if one of the old Patient Relationship to Insured codes is reported.
POA Implementation Delay - April 19, 2007
IMPLEMENTATION OF POA IN THE TENNESSEE HOSPITAL DISCHARGE DATA (STATE REPORTING) WILL BE DELAYED UNTIL DISCHARGES ON OR AFTER JANUARY 1, 2008!
The State has decided to delay implementation of the Present on Admission (POA) indicators until January 1, 2008. This delay will be consistent with the CMS delay and allow for additional time to clarify the capture and coding of this very important information. You should receive a letter soon from George Wade, Tennessee Department of Health, to this effect.
Updated Payer Classification Codes - March 2007
Recently the payer classification codes to be used in reporting hospital discharge data were updated to include new codes for the three (3) programs under Cover Tennessee: CoverTN, CoverKids, and AccessTN. There is also a new payer code for the new MCO (Amerigroup) that will be effective April 1, 2007. download >>>
PhysicanCode Reporting Changes - March 2007 Effective with October 2006 discharges hospitals are required to submit provider fields in the 1600-character UB-92 record differently... more info >>>