UB-04 Correspondence

TDH Request for Information on UB-04 Data Reporting - October 31, 2014

The Tennessee Department of Health (TDH) mailed all licensed Tennessee Hospitals a letter requesting information on your quarterly UB-04 data submissions. A copy of the letter can be viewed by clicking here. The TDH plans to send this data information request annually, each November. They are asking each hospital to submit the form, PH-3925 Reporting Method Sheet (click here to download a copy of this form) by November 15th to the specified email, fax or mailing address located on the form.

When filling out the reporting method sheet, THA member hospitals should select, under section III, third quarter and use the date you submitted your data to THA via the Remote Discharge Data System (RDDS). If you have not yet submitted your Q3-2014 data, due by November 29th, still choose third quarter and indicate the anticipated submission date, not to exceed November 29th. As a gentle reminder, facilities failing to submit UB-04 discharged data to THA will be subjected to the penalties proscribed under T.C.A. 68-1-108.

Also, please be aware the attached reporting method sheet states all hospitals must complete and return the form signed and dated, each and every quarter. This is a misrepresentation as the form, for these purposes, is only due on an annual basis. THA did clarify this with the TDH contact, Nerissa Harvey.

Please contact Larissa Lee at THA if you have any questions regarding this request from the TDH.


Notice – Penalty for Late Submission of UB Discharge Data – October 3rd, 2014

On October 3, 2014, the Tennessee Department of Health (TDH) mailed all licensed Tennessee hospitals a letter reinforcing penalty for failure to report. The TDH will begin enforcing the penalties associated with delinquent reports having a Statement Covers Period through Data on or after January 1, 2015. The implementation of this section of the T.C.A. at this date is in hopes to receive more complete and higher quality data. Hospitals that are currently delinquent on the date of implementation will not be charged for the previously delinquent records, but delinquencies after that date will be assessed the penalties. The letter sent by TDH can be viewed by clicking here.

THA has a process set in place to remind you of quarterly data submission deadlines. This process has not changed and will continue as it has in the past. Below are the quarterly reporting due dates for hospital UB discharge data submission:

  • January - March (Q1) discharge data are due to be submitted no later than May 30th.
  • April - June (Q2) discharge data are due to be submitted no later than August 29th.
  • July - September (Q3) discharge data are due to be submitted no later than November 29th.
  • October - December (Q4) discharge data are due to be submitted no later than March 1st of the following year.

Each quarter Nora Sewell, HIN Data Analyst, sends reporting reminders to hospitals, usually no less than a month before a reporting due date. Once the scheduled due date (as outlined above) has passed, Nora notifies the TDH of those hospitals who have not submitted their UB discharge data by the specified scheduled date. In the future, these hospitals could run the risk of being fined for failure to submit discharge data according to schedule.

There are three main characteristics every data system should strive for: timeliness, accuracy and completeness. Please help us keep the data quality and integrity high as it will only serve you, THA member hospitals, the most precise data possible.

Please contact Larissa Lee if you have any questions.


Inpatient and Outpatient Replacement Bills – September 30, 2014

Inpatient Replacement Bill Type 0117
As you are aware, bill type 0117 indicates an inpatient replacement bill. If this bill type is submitted to the THA RDDS, the system will search the database for a previous claim by comparing key elements. Once the previous claim has been located, the replacement bill (0117) will overlay the original record and the bill type will be changed from 0117 to 0111.

Please note: If a replacement bill (0117) cannot be linked to a previous bill, the replacement bill will become the database record and the bill type will be changed to 0111.

Outpatient Replacement Bill Type 0137
Similar to the above statement, bill type 0137 indicates an outpatient replacement bill. If this bill type is submitted to the THA RDDS, the system will search the database for a previous claim by comparing key elements. Once the previous claim has been located, the replacement bill (0137) will overlay the original record and the bill type will be changed from 0137 to 0131.

Please note: If a replacement bill (0137) cannot be linked to a previous bill, the replacement bill will become the database record and the bill type will be changed to 0131.

Please contact Larissa Lee, llee@tha.com, or Nora Sewell, nsewell@tha.com, if you have any questions.
 


RECOMMENDATION to TN Department of Health related to OP procedure reporting - March 17th, 2014

THA, with support of the THA Data Policy Committee, has made a recommendation to the TN Department of Health (TDH) to change the way outpatient records are reported beginning with October 1, 2014 claims (when ICD-10-PCS codes are implemented). This change, IF APPROVED by TDH, would discontinue the requirement of hospitals to report outpatient principal procedure using ICD-9 procedure codes and rely on the HCPCS/CPTs reported in outpatient records for this determination. Reporting of HCPCS/CPTs when applicable on outpatient records have been required in the Hospital Discharge Data System since 2007 when the record reporting format changed from the UB-92 to UB-04.

The current definition used for ambulatory surgery relies on ICD-9 procedure codes in the range 00.01-86.99. The THA recommendation – to rely on the CPTs reported -- would require a new definition for ambulatory surgery using CPT surgery codes 10021-69990. Required outpatient reporting would also include a range of CPTs outside the surgery range that are used to report CON-covered services such as cardiac catheterization (93451-93453, 93456-93461, and 93530-93533) and electrophysiological studies (93600-93603, 93610, 93612, 93615-93620, 93624, 93631, 93640-93642, 93650, 93653-93654, 93656 and 93660).

THIS RECOMMENDATION WILL ONLY TAKE EFFECT IF APPROVED BY THE TENNESSEE DEPARTMENT OF HEALTH.

IF this recommendation is approved, the CPT with the highest ambulatory patient classification (APC) weight will be considered the ‘principal procedure’. The highest weighted CPT or ‘principal procedure’ determination will be made by THA staff each quarter by applying the appropriate APC weights in effect for the date of service provided in each record. Reporting hospitals will not be responsible for making this determination; hospitals will only be responsible for submitting the appropriate HCPCS/CPTs on the outpatient records. Outpatient records will be assigned to procedure product lines for analysis based on this ‘principal procedure’, or highest weighted CPT, beginning with the October 1, 2014 outpatient claims.

This recommendation was discussed at the recent THA board meeting and the board agreed with the recommendation. They also asked that this information -- even though it has not yet received FINAL APPROVAL from TDH -- be shared with THA member hospitals to make them aware of the change that has been requested.

THA is waiting to hear from the department about this request and will notify hospitals as soon as a response is received. We have also asked the department to notify hospitals as soon as possible if this change is approved.


Patient Discharge Status code 69 effective October 1, 2013 discharges - September 17th, 2013

There is another new Patient Disposition (discharge) Status code (Form Locator 17) that will be effective October 1, 2013. Please share this information with the appropriate people in your hospital/health system. Discharge status code 69, Discharged/transferred to a designated disaster alternative care site is effective with October 1, 2013 discharges. Here’s some info about the use of code 69:

An alternate care site (ACS) provides basic patient care during a disaster response to a population that would otherwise be hospitalized or in a similar level of dependent care if those resources were available during the disaster. The federal government or state government must declare the disaster. ACS is not an institution; most likely it would be an armory or stadium. There would be no self-referrals to the ACS. All patients must be referred after triage. There would be no room and board charges and would be all-inclusive with no ancillaries reported separately.

 


HCPCS and CPTs on Outpatient Records - June 17th, 2013

It is extremely important that hospitals are currently reporting all HCPCS and/or CPT codes on all outpatient records in the HCPCS/CPT fields in positions 285-606 in the UB-04 record format. Currently, the Tennessee Department of Health (TDH) requires hospitals to report all HCPCS/CPTs on outpatient records and if a procedure was provided, to also report the principal procedure using ICD-9 procedure codes. This requirement presents a dual-coding dilemma on the outpatient data that hospitals have struggled with over the last several years. With the implementation of ICD-10 coming in October 2014, THA is discussing this process with TDH to see if an alternate process can be approved. ICD-10 PCS coding is extremely different from ICD-9 procedure coding and since ICD procedure coding is not standard for billing purposes on the outpatient side, it creates a data validity and reliability issue with what is being reported.

PLEASE BE AWARE: The dual-coding requirement has NOT YET CHANGED, therefore, hospitals must continue reporting the outpatient data both ways (using HCPCS/CPTs and ICD-9 procedure codes if procedure was performed) until notified differently. THA hopes to get the requirement to report the principal procedure on outpatient records using ICD-10 PCS codes dropped when ICD-10 codes are implemented (October 2014) however, this is still an on-going discussion with TDH. We will keep you informed on our progress.


New Warning edit to become Fatal edit with October 2013 discharges - May 7th, 2013

Hospitals should hear from the TN Department of Health about this new edit soon. It has already been added as a Warning edit to THA RDDS so if you have any concerns with this edit, please let us know as soon as possible.

Click here for is the list of revenue codes that will require CPT code to be reported. (While HCPCS information is also required when relevant, the edit will focus on these revenue codes and expect a CPT code to be reported with them.) However, we understand that there may be some exceptions with some payers (i.e., TennCare MCOs) not requiring HCPCS/CPTs on some of these revenue codes. We would like to hear from you as soon as possible if you see problems with the list of revenue codes requiring CPT so we can work with the Department to modify the edit for these exceptions BEFORE the edit becomes FATAL.

HCPCS/CPT Codes Edit for Outpatient Data Reported to the Hospital Discharge Data System

With the change to UB-04 reporting in 2007 HCPCS/CPT codes became required to be reported when relevant on outpatient records. However, we have found that some facilities have not been including the HCPCS/CPT codes on their outpatient records.

Therefore we are establishing a set of edits to check for the presence of these codes for outpatient records containing selected revenue codes. A list of the revenue codes requiring the reporting of the corresponding HCPCS/CPT code is enclosed.

Initially this edit will only generate a warning. But, beginning with discharges on or after October 1, 2013 this will become a fatal edit. The Quarter 4, 2013 data is due to the Department of Health or to the THA Health Information Network on or before March 1, 2014. Please ensure that you are reporting your HCPCS/CPT codes by that time.

Please contact Jean Young (jyoung@tha.com) or Nora Sewell (nsewell@tha.com) as soon as possible if you have questions or concerns about one or more of these revenue codes and this edit. Thank you!

 


How to submit TEST data through THA RDDS - January 3rd, 2013

The process to submit TEST data through THA RDDS is different from the process used in the past when test data was submitted through HIDI. Please be sure to follow the steps below when submitting TEST data through THA RDDS.

  1. Using RDDS, all TEST files should use discharge records that have not yet been submitted. TEST records should have discharge dates later than records already on RDDS for your hospital. In other words, if you have already submitted Q2 data for your hospital and it is within the fatal error threshold (no more than 2%), any TEST data should be for Q3 or later, or even a smaller submission that includes data for one month, (i.e., July data) would be acceptable to submit as a TEST file.
  2. Once the TEST file has processed and you have checked it to make sure the change you were making is working properly, you MUST DELETE the Batch (by number) that RDDS assigned to the TEST file when it was submitted.
  3. It is also recommended that THA HIN staff be notified in advance if you plan to submit TEST data so we can be aware and communicate this if necessary with the processing system. Notify Nora Sewell (nsewell@tha.com) or Jean Young (jyoung@tha.com).

If there are any questions, please contact Jean or Nora to discuss.


Revision to the THA Data Policy - September 17, 2012

The THA Board of Directors met on September 14th and they approved the most recent changes to the THA Data Release Policy recommended by the THA Data Policy Committee. These changes – related to the use of Blue Cross consumer data -- are identified in blue print on this copy of the THA Data Release Policy (20120914 version).

THA will also contact Blue Cross and ask them to add a statement to their consumer website indicating the data may not be extracted and used in any public release by anyone without THA approval.


Risk of penalty for late reporting of UB discharge data - September 11, 2012

As required by our agreement with the TN Department of Health that allows us to process the quarterly hospital discharge data for our members, THA Health Information Network (THA HIN) is required to provide to the Department a list of hospitals that fail to report the UB discharge data by each quarterly due date. We communicate regularly with the HIN contacts in each facility if reporting is late. However, we also need to notify the CEO at each of these hospitals if the data is not submitted on time because the facility is at risk of being penalized for failure to submit the data by the due date.

THA staff often meets with the TN Department of Health staff to discuss issues and concerns about discharge data reporting requirements. One issue that continues to be brought up by the Department is the timeliness of reporting by hospitals. Below are the quarterly reporting due dates for hospital discharge data submission. According to regulations, the Department has the ability to financially penalize hospitals that do not submit data according to the reporting schedule below.

  • January - March (Q1) discharge data is due to be submitted no later than May 30th.
  • April - June (Q2) discharge data is due to be submitted no later than August 29th.
  • July - September (Q3) discharge data is due to be submitted no later than November 29th.
  • October - December (Q4) discharge data is due to be submitted no later than March 1st of the following year.

THA RDDS Update - April 17th, 2012

Be sure to check the Load Report after every submission of 2012 UB discharge data to THA RDDS. Records that do not load will not be added to the State’s discharge database. Below are the reasons a record will not be loaded.

  • Bad Discharge Dates
  • Bad Hospital IDs
  • Bad Bill Types
  • Bad Record Lengths
  • Duplicate Records

Be aware that you may get a message “Bad Hospital IDs” for one of several reasons:

  1. This message may appear if an invalid or no Joint Annual Report ID number is provided in positions 2046-2050 of each discharge record.
  2. Some files are generating the message “Bad Hospital IDs: 1” because there is an extra carriage return line feed in the file (an empty record at the bottom of the file). To prevent this message, remove the extra carriage return line feed from the file that is submitted to THA RDDS.

Let Jean Young or Nora Sewell know if you have any questions or we can assist you in any way.


THA RDDS Update - April 13th, 2012

As you know, we are moving to THA RDDS with the Q1 2012 UB discharge data submissions. As the due date for Q1 2012 submission gets closer I wanted to make you aware of some of the major differences between the new RDDS site and the HIDI site we’ve used for the past several years.

  1. The new THA RDDS site requires a new login and a new website https://www.hidionline.com/thardds/Login.aspx to submit data, make corrections, and review the reports. Nora Sewell has been contacting everyone to get the new logins set up but if you are unsure about your login information or how to access the new site, please contact Nora at (615) 401-7426 or nsewell@tha.com. Nora will be the point of contact for THA member hospitals using the new system. If you have any questions, you should contact Nora first.
  2. Ideally, the file submitted each quarter by a hospital will contain all inpatient and outpatient data for that quarter.

    - IF you cannot submit all inpatient (IP) and outpatient (OP) data for a given quarter in one file, as long as the separate IP/OP files are submitted on the same day (before 6:00 p.m. CST), both files should be processed together and one document (pdf file) containing both your inpatient and outpatient edit summary reports will be emailed to all of the individuals who are set up as RDDS website users for your facility or facilities. The email will come from “THA User”.

    - IF the separate IP and OP files cannot be submitted on the same day prior to 6:00 p.m. CST, two (2) separate reports (pdf files) will be generated (one for IP and one for OP). These separate reports will be emailed via two (2) separate emails to all of the individuals who are set up as RDDS website users for your facility or facilities. The first set of reports will be for the first file that is submitted and the second set will be a cumulative set that includes reports for both files.
  3. Once data is uploaded successfully to the system, you will receive a “Batch ID” number. Use this batch ID number as a confirmation number to review the reports associated with each file that is uploaded.
  4. To submit a TEST file upload the file to THA RDDS, check the reports from the test file, and delete the test file submission using the batch ID number associated with it as soon as possible. Please do NOT forget to delete a test file after the test file reports have been reviewed. Failure to remove these test files could result in duplicate records which are considered ‘fatal’ errors when the real data is submitted. Since this system is more ‘remote’ HIDI staff will not monitor the removal of test files. Hospitals must ensure that the discharge records on the system accurately reflect the services provided during the quarter.
  5. To replace a previous submission of data (i.e., a submission has excessive errors or there are other problems with the original file and you wish to replace it) first, you will need to delete the original batch ID number using the “Delete” link on the Status page. Once you click “Delete”, a job will be queued to delete the batch and regenerate your Edit and Verification reports. The designated contact(s) will receive an email once this process has completed.

    These requests are processed first in/ first out, so if you DELETE a batch, you should get an email notification regarding the DELETE reports first, followed by another email notification regarding the reports for the RESUBMIT. Whether you choose to wait to check the DELETE reports before doing the RESUBMIT is up to you, but if you do, it may help avoid confusion.
  6. Discharge records that do not contain the hospital’s 5-digit Joint Annual Report ID number (JARID) in positions 2046-2050 WILL NOT LOAD into the database. This could result in incomplete data submissions. If you do not know what your hospital JARID is, contact Nora.
  7. If a record has a fatal error, the online corrections screen on THA RDDS allows you to change any field in that record. Fatal errors will be highlighted in red, warnings in yellow, and informational messages will be highlighted in blue. You must click the SAVE button to save the corrections you make.

Notice - Potential penalty for late submission of 2012 UB discharge data! - April 12th, 2012

There are three (3) main characteristics every data system should strive for: timeliness, accuracy, and completeness. Data systems that are developed without addressing all three of these features are often not useful and can lead to poor planning and incorrect decisions.

THA staff often meets with the TN Department of Health staff to discuss UB discharge data reporting issues and concerns about data reporting requirements. One issue that has been brought up recently by the Department is the timeliness of reporting by hospitals. Below are the quarterly reporting due dates for hospital discharge data submission. According to regulations, the Department has the ability to financially penalize hospitals that do not submit data according to the schedule below. To date, however, no THA member hospitals have ever been penalized for any reason.

  • January - March (Q1) discharge data is due to be submitted no later than May 30th.
  • April - June (Q2) discharge data is due to be submitted no later than August 29th.
  • July - September (Q3) discharge data is due to be submitted no later than November 29th.
  • October - December (Q4) discharge data is due to be submitted no later than March 1st of the following year.

The Department of Health has asked THA to submit information to them within 3 days after each of the reporting due dates indicating 1) which hospitals submitted data, and 2) the volume of IP and OP data that was submitted by the due date. (If a hospital doesn't see outpatients, we will notify the department of this when the information is provided to them.) At this time, timeliness of the initial quarterly submission is the only issue TDH is asking for help in addressing. We believe there are already good processes in place at the hospitals and in THA to ensure the accuracy and completeness of the data are addressed by the time we provide the quarterly data to the Department.

Each quarter Nora Sewell sends reporting reminders to hospitals, usually at least a month before a reporting due date. Most hospitals either submit data earlier than the due date or at least meet the reporting due date. But there are usually about 15 hospitals each quarter that Nora has to contact because they are late submitting the data. In the future, these hospitals could run the risk of being fined for failure to submit discharge data according to the schedule.

I wanted to take this opportunity to make each of you aware that THA will be providing this information to the Department starting with the Q1 2012 discharges that are due to be submitted by hospitals no later than May 30, 2012. I suggest that you discuss the reporting schedule with others in your facility, especially if you rely on them to assist with discharge data submissions, and explain that meeting the quarterly submission due dates is very important.

Also, remember that all 2012 UB discharge data must be submitted to the new THA Remote Discharge Data System (THA RDDS) using the website address https://www.hidionline.com/thardds/Login.aspx. If you have any questions about any of the information or processes related to UB discharge reporting, please contact Jean Young at (615) 401-7429 or Nora Sewell at (615) 401-7426.


Additional Information on THA RDDS - March 1st, 2012

Everyone should be aware that we are moving to the new processing system, THA RDDS with the 2012 UB data submissions. If you haven’t signed up to be a user of RDDS, please notify Nora Sewell (nsewell@tha.com) as soon as possible so she can get you set up with a username and password for access.

THA RDDS is the new system used by THA member hospitals to upload quarterly (or monthly) UB data that is required by state law. This system also allows for processing reports to be viewed and corrections to be made online. THA staff (rather than MHA HIDI staff) will be more prominent in the processing of 2012 data once we move to RDDS. HIDI is still supporting the new system for us but they will do more of the technical system support rather than the day-to-day support of our members.

We had asked several hospitals to submit ‘test files’ of 2011 data through the new RDDS system so we could ensure reliability and accuracy of the output reports. Thank you to the hospitals that helped us with this testing. It required dual submissions of the Q3 and/or Q4 2011 data and comparison of the output reports from the (old) HIDI system and the (new) RDDS. To safely move over to RDDS for 2012, we ask that no additional 2011 ‘TEST’ data be submitted on RDDS AFTER March 16, 2012 at 4:00 p.m. CST.

When you submit your Q1 2012 data to RDDS, it may have some leftover 2011 records that need to be submitted and that will not be a problem. By discontinuing the testing of 2011 data after March 16, we will be able to merge and move the 2011 data on HIDI over to RDDS without duplications. (The 2011 data is used for over-time comparisons for the new 2012 data in the output reports.)

Some other important facts about RDDS:

  • IF you would like to submit a ‘TEST file’ of 2012 data through RDDS, you will be responsible for DELETING the file before the data is submitted for real. RDDS doesn’t use the designation of ‘TEST files’ so every submission is treated as a real file until it is deleted by the facility.
  • This same rule applies to ‘REPLACEMENT files’. If you need to replace a data file on RDDS (i.e., due to large number of errors in the original file submitted), you must DELETE the original file using the BATCH ID NUMBER assigned to it upon submission. Once the original BATCH ID NUMBER has been deleted, you can then replace the submission with the corrected data file.

THA RDDS - Notice of system change for 2012 - October 17th, 2011

Responsibility for processing the state required UB discharge claims data for THA member hospitals will be handled in-house by the THA staff beginning with 2012 UB discharge claims. Our data partner, Hospital Industry Data Institute (HIDI) has developed a more efficient and automated discharge system that will allow THA staff to be more involved in the day-to-day processing of the data. Also, we have a new name for the discharge claims processing system: THA Remote Discharge Data System, or THA RDDS.

THA RDDS will mean the following to our members:

  1. A new website address will be used to submit the data starting with discharges occurring on or after January 1, 2012.
    This website address is https://www.hidionline.com/thardds/Login.aspx. Note that the new website address includes ‘hidionline’ and ‘thardds’ in the website address.

    VERY IMPORTANT: Facilities must continue to use the current HIDI website address (https://www.mhanet.com/hidinet/default.aspx) for reporting ALL 2011 discharge information. DO NOT use the new website (that includes 'hidionline' and 'thardds' in the website address) for submitting the remaining 2011 data!
  2. HIDI will continue to house the secure encrypted data collection system and provide redundant backups both locally and offsite nightly.
  3. THA RDDS will maintain the same quality of service with additional convenience and flexibility with minimal changes for our members.
  4. Communications about data submitted will now come from THA staff rather than from Darrell Jungmeyer at HIDI.

Beginning in early 2012, THA will provide more information about THA RDDS and the changes it will bring. Be watching your mail and please share this information with others who are involved in discharge reporting in your facility!

 


New FATAL edits with January 2012 discharges - September 6th, 2011

The THA Data Policy Committee met last week and discussed the edits listed below. The Tennessee Department of Health will require that the following conditions that are currently Warnings will become FATAL edits with January 2012 discharges. The January-March 2012 discharges are due to be reported no later than May 30, 2012, but you will need to work with your staff to ensure that these conditions are addressed before that file is submitted.

Edit # - MESSAGE
2705 - Principal procedure is present (in positions 1856-1862) but there is no Operating physician UPIN/NPI reported (in positions 1983-1995).

2706 - Principal procedure is present (in positions 1856-1862) but there is no Operating physician Profession Code + TN License Number reported (in positions 1971- 1982).

Please share this information with each person in your facility who is involved in state required hospital discharge reporting activities. If you have any questions, feel free to contact Jean Young (jyoung@tha.com) or Nora Sewell (nsewell@tha.com or (615) 401-7426) to discuss.


Importance of reporting correct NPI in each discharge record - July 22nd, 2011

The UB-04 reporting format requires the hospital NPI be reported in positions 1497-1511 in each 2538-character record submitted. It is very important that the NPI reported in these positions accurately reflect the NPI for where the patient was treated – including the distinct part units such as psych or rehab units.

If a patient is treated as acute care, the acute care NPI should be reported in the record in positions 1497-1511. However, if your hospital has a psych or a rehab distinct part unit, the discharges from these units should report the NPI for that specific unit. Failure to report the NPI correctly may create high fatal error rates related to the absence of ‘Present on Admission’ (POA) information since POA information is not required on psych and rehab cases. Incorrect NPI reporting may also affect the analysis of your data related to charges and average length of stay if the psych/rehab cases are included with the acute care cases.

Please work with your IT staff or your vendor to ensure that the NPI that is being reported in each discharge record is accurate for the type of discharge being submitted.


TennCare MCO Americhoice name changed to UnitedHealthcare Community Plan - July 6th, 2011

The TennCare managed care organization (MCO) Americhoice changed its name to ‘UnitedHealthcare Community Plan’ on January 1, 2011. Payer code ‘8’, previously used to designate Americhoice, should be used to designate UnitedHealthcare Community Plan as the payer in the UB discharge data.

Click here to download a revised payer codesheet to use for UB discharge reporting. You may want to print it and insert it in your new version of the 2011 Hospital Discharge Data System Manual so you will have the most up-to-date payer codes. This change should be applied to all three payer code fields (primary, secondary, and tertiary payer codes).


2011 Hospital Discharge Data System (HDDS) User Manual is now available - June 15th, 2011

The Tennessee Department of Health (TDH) has recently completed the 2011 Hospital Discharge Data System (HDDS) User Manual. This manual incorporates all changes and/or clarifications that have been released since the 2007 version of the HDDS manual was made available. Click the link above to download the new manual.


ICD-10 implementation for required hospital discharge reporting - June 1st, 2011

Click here to download the letter the TN Department of Health sent to all hospitals today related to the implementation of ICD-10 diagnosis and procedure codes. Let us know if you have any questions.


Edits that will become Fatal with Q1 2011 discharges - March 16th, 2011

The following edits are currently considered Warnings in the processing of inpatient UB-04 discharge data. When the Q1 2011 discharge data is submitted (due by May 30, 2011) these 3 edits will become Fatal errors (inpatient records only).

  • 7103 – ER admit code is invalid (pos. 2272 is not equal ‘Y’ or ‘N’)
  • 7104 – ER admit code is missing (pos. 2272 is blank)
  • 7105 – CMS surgical error code is invalid (pos. 2273-2274 is not MX, MY, MZ or blank)

Quarterly UB Data Submission Timeliness - February 8th, 2011

There are three (3) main characteristics every data system should strive for: timeliness, accuracy, and completeness. Data systems that are developed without addressing all three of these features are often not useful and can lead to poor planning and incorrect decisions.

THA often meets with the TN Department of Health to discuss UB discharge data reporting issues and concerns about data reporting requirements. One issue that has been brought up recently by the Department is the timeliness of reporting by hospitals. Below are the quarterly reporting due dates for hospital discharge data submission. According to regulations, the Department has the ability to financially penalize hospitals that do not submit data according to the schedule below. To date, however, no THA member hospitals have ever been penalized for any reason.

  • January - March (Q1) discharge data is due to be submitted no later than May 30th.
  • April - June (Q2) discharge data is due to be submitted no later than August 29th.
  • July - September (Q3) discharge data is due to be submitted no later than November 29th.
  • October - December (Q4) discharge data is due to be submitted no later than March 1st of the following year.

Please be aware that the Department is considering requiring THA to submit information to them the day after each reporting due date (on May 31st, August 30th, November 30th, and March 2nd) indicating which hospitals submitted data and what data was submitted for the quarter by the due date. At this time, timeliness of the initial quarterly submission is the only issue they are addressing. We believe there are good processes in place both at HIDI and at THA to ensure the accuracy and completeness of the data are addressed by the time we provide the provisional data for each quarter to the Department.

Each quarter Nora Sewell sends reporting reminders to hospitals, usually the first of the month when there is a reporting due date. Most hospitals either submit data earlier than the due date or at least meet the reporting due date. But there are usually about 15 hospitals each quarter that Nora has to contact because they are late submitting the data. In the future, these hospitals could run the risk of being fined for failure to submit discharge data according to the schedule.

We just wanted to take this opportunity to make each of you aware of this possibility. If the Department proceeds with this request, I will notify each of you. However, in the meantime, you might want to discuss the reporting schedule with others in your facility, especially if you rely on them to assist with discharge data submissions, and explain that meeting the quarterly submission due dates is very important.


Revised THA Data Release Policy per Sept 17 2010 THA Board Meeting - September 20th, 2010

Click here to download the revised THA Data Release Policy approved by the THA Board of Directors at the September 17, 2010 meeting. This policy has been changed per the Board’s instruction and these changes are noted in blue on the attached copy.

Please share this information with anyone who may be working with the THA HIN data so they will be aware of the limitations and prohibitions on release of this information.


Revised instructions for Reporting No-Pay Inpatient Claims - September 7th, 2010

This letter from the TN Department of Health was recently sent to all Tennessee hospitals. This letter changes the instructions previously provided by the Department for reporting inpatient discharges that reflect the occurrence of wrong procedures, wrong patients, or wrong sites.

CMS revised the instructions for reporting these occurrences and this letter allows the information reported to the TN Department of Health to be consistent with the revised CMS instructions.


Revised UB Discharge Record Format 2010 - August 4, 2010

In March 2010, the TN Department of Health revised the UB discharge 2538-character record format to add fields in positions 2272 and 2273-2274. In June 2010, a revised UB record format was sent to hospitals however, the record format needed 2 minor changes.

Please note that this version (20100804-UB04-Data-Record-Format-updated.pdf) of the record format includes the following:

  1. Updated name of Field 18 from Source of Admission to "Point of Origin or Visit", and
  2. Changed Field 254 from Medicare Provider Number to "Joint Annual Report ID Number" (positions 2046-2057)

These field labels are shown in red on the attached format.

If you have any questions, please contact Jean Young at THA.


Point of Origin Update - July 12, 2010

Click here for a revised code sheet for the Point of Origin (PoO) codes effective with July 1, 2010 discharges. This code sheet no longer includes PoO code ‘7’ (Emergency Room) but it may include information that will help you determine what PoO code to use instead.


Information on new fields required by TDH in March 2010 letter - June 22nd, 2010

We have received several requests from hospitals for additional information on the new fields outlined in the TN Department of Health (TDH) letter to hospitals dated March 19, 2010. I am glad to take these questions to the TDH to see if we can clarify and answer these questions. Below are some points of clarification related to the 2 new fields that were identified in the March 19, 2010 TDH letter (specifically position 2272 and positions 2273-2274).

  • Hospitals generally have 180 days from the date of the letter to implement any changes identified by the TN Dept of Health. Since the letter was dated March 19, that would mean that generally by Sept 19, 2010 these changes should be implemented and discharges submitted after that date would be required to have these new fields incorporated. However, I have just talked with George Wade at TDH and he has agreed to extend the period allowed for hospitals to make these changes. THEREFORE, ANY RECORD WITH DISCHARGE DATE OF OCTOBER 1, 2010 OR AFTER MUST INCLUDE THESE NEW FIELDS IDENTIFIED IN THE MARCH 19, 2010 LETTER. If your vendor can include these fields on discharges before then, that will be acceptable but these new fields must be included if the discharge date is Oct 1, 2010 or after.
  • The use of pos. 2272 to denote that the patient was first seen in the hospital’s ER applies to ALL discharges (inpatient and outpatient). Report as ‘Y’ if the patient was seen in the hospital’s ER; report as ‘N’ if not.
  • The use of pos. 2273-2274 to denote that there was a wrong surgery/wrong site/wrong patient situation in the hospital applies to INPATIENT discharges only. If one of these conditions occurs on the outpatient side, the appropriate modifier (PA, PB, or PC) should be attached to the HCPCS/CPT.

If you or your vendor has other questions regarding these new fields, or other parts of the March 19, 2010 letter from the Department, let us know and we will discuss them with the Department.


MORE information on discontinuation of Point of Origin code 7 - June 7th, 2010

Several hospitals have asked what Point of Origin (POO) code would be used instead of POO 7 if the patient was seen in the ER. There is no replacement POO code for 7. POO should reflect where the patient came from before presenting to the health care facility. Click here for some information from the National Uniform Billing Committee related to this change affecting POO 7.

Note the reference to new Condition Code ‘P7'. Condition Code 'P7' indicates that the patient was admitted directly from this facility’s Emergency Room/Department. The March 2010 letter from the Dept of Health directs hospitals to submit ‘Y’ in position 2272 of the record if the patient was admitted from the facility's ER/ED. This direction also applies if there is a condition code P7 in the record. Otherwise submit ‘N’ in position 2272.

Contact Jean Young at 1-866-284-2446 if you have questions. 


Point of Origin code 7 discontinued on July 1 2010 - June 3rd, 2010

As mentioned in the March, 2010 letter from the TN Department of Health, Point of Origin (POO) code ‘7’ will become invalid and the use of this code should be discontinued on discharges occurring after June 30, 2010. Point of Origin code ‘7’ indicates a patient received services in the Emergency Room.

Also from the March, 2010 letter all discharges July 1, 2010 and after should have a ‘Y’ reported in position 2272 of the 2538-character record if the patient came through the Emergency Room. If the patient did not come through the Emergency Room, position 2272 should be reported as ‘N’. Thus, for discharges on or after July 1, 2010, all records should include either ‘Y’ or ‘N’ in position 2272.

  • POO code ‘7’ reported on discharges on or after July 1, 2010 will be considered Fatal errors.
  • Blanks or invalid codes (codes other than Y or N) in position 2272 on discharges between July 1, 2010 and December 31, 2010 will be considered Warning errors. (This is a temporary edit delay offered by the Department to allow hospitals more time to get this new field set up.)
  • Blanks or invalid codes (codes other than Y or N) in position 2272 on discharges January 1, 2011 and after will be considered Fatal errors.

Contact Jean Young at 1-866-284-2446 if you have any questions about this information.


Letter from TN Dept of Health - March 19th, 2010

Click here to view a letter from George Wade, Manager of the Hospital Discharge Data System (HDDS) in the TN Department of Health that addresses several changes and/or clarifications to the UB discharge reporting procedures. Each hospital should receive this letter directly from the Dept, and we have also emailed a copy to the UB discharge policy and technical contacts in each THA member hospital.

As a reminder, all changes/clarifications that come from the Dept or from THA are posted in this area (in most recent date order) of our site.


Payer codes D, N, and T - Clarifications - March 22nd, 2010

  • PAYER CODE 'D' indicates "Medicaid (not TennCare)" is the payer for services. This payer code should be used for out-of-state residents receiving care in TN hospitals who have traditional Medicaid in their resident state (not TennCare). This code may also be appropriate for Tennessee residents receiving services that are paid for directly by the State. On occasion there are cases of TN residents where Medicaid (not TennCare) is paying for services. These program payments don't go through the MCOs -- they go straight to the provider from the State.
  • PAYER CODE 'N' indicates "Division of Health Services and government payers not otherwise coded". This payer code is used for services provided by Vocational Rehabilitation (Voc Rehab), care provided to prisoners that is paid for by the state, and care provided to mental health patients that is covered by the Dept of Mental Health.
  • PAYER CODE 'T' should be used for patients that have TennCare-Medicare supplement as secondary or tertiary payer (i.e., QMB patients). Payer code ‘T’ indicates "TennCare, not otherwise specified". There is a 10% limit on the use of payer codes ‘T’ (TennCare, NOS) and ‘O’ (Other, unknown payer), however, these limits are applied to the primary payer ONLY. The use of payer code ‘T’ reported for secondary or tertiary payer will not be affected by the 10% limit that is applied to primary payer.

REVISION to definition of Payer Code "N" - October 19th, 2009

We have been notified that some hospitals provide services to a large number of prisoners. If these services are provided through an agreement with a payer (i.e., a managed care payer/organization), it is appropriate to report the payer code that correctly identifies that payer. However, if the payer for these prisoners is not covered by an existing payer code, these records should be reported using payer code “N” from now on.

The definition for payer code “N” is changed effective October 19, 2009 as follows:

N = "Division of Health Services (Voc Rehab) and government payers not otherwise coded"

Use this payer code when services are provided to prisoners that are not covered by an appropriate payer code. Do not use payer code “O” for services provided to prisoners. The definition of payer code “N” is being revised to help hospitals prevent overuse of payer code “O” (more than 10%).


New Patient Discharge Status code 21 - October 6th, 2009

A new code, 21, has been added to Form Locator 17, Patient Discharge Status. This new code is effective with October 1, 2009 discharges and it is used to designate “discharged/transferred to court/law enforcement”. This code includes transfers to incarceration facilities such as jail, prison, or other detention facilities.


MODIFIED LIST of Fatal Edits for July 2009 discharges - September 22nd, 2009

This list of Warning edits will become FATAL edits with the processing of July-September 2009 discharges. These 3rd quarter 2009 discharges are due to be submitted no later than November 29, 2009. A few edits on the list have been DELAYED since this list was first sent out in April 2009 so please look at the updated list.

HIDI has been printing these edits in blue print on the error summary/error detail reports when the rate is more than 2%. This blue print indicates that these are conditions that will soon be FATAL errors and they need to be looked at by the hospitals and/or their data vendors BEFORE the 3rd quarter 2009 discharge data is submitted.

Some of these new fatal edits will become “Fatal but Verify” edits. This means that the record is considered to have a fatal error but if the hospital verifies that the data related to the error condition is correct as reported, the hospital will be able to indicate this on the HIDI online website. Based on this verification, the fatal flag due to this error condition will be removed. Some of these edit conditions are identified in the Medicare Code Edits as incorrect but in reality they may represent true conditions.

For example, the error message ‘Age is less than 15 and principal diagnosis is appropriate for adults only’ is flagged as a Fatal error. A review of the medical record verifies that the data of birth and principal diagnosis are reported correctly. The hospital will be able to verify that the data -- although it may look incorrect -- is correct as reported based on the information documented in the medical record.

If you have any questions about this information, please contact Jean Young.


Revenue unit and revenue charge edits - July 17th, 2009

Until further notice, all three of the following edits will remain as WARNINGS.

  • Edit 3801 - Revenue units are missing
  • Edit 3804 - Revenue units are zero
  • Edit 3901 - Revenue charge is missing

A delay had previously been announced for edit 3804 and edit 3901 to become fatal edits; however, due to comments from several hospitals, it was determined that edit 3801 could also be problematic. More research will be done before these edits move to the fatal edit list. 


Revenue unit and charge edits on UB discharge data - June 18th, 2009

The following 2 edits will remain as WARNINGs until further notice. These edits are currently WARNINGS and were scheduled to become FATAL errors with the submission of July-September 2009 discharge information. This delay will allow more time for further research on the impact of these edits on the data that is being submitted by hospitals.

  • Edit 3804 - Revenue units are zero
  • Edit 3901 - Revenue charge is missing

The following edit will become FATAL with the July-September 2009 discharge information. This edit is currently considered to be a WARNING:

  • Edit 3801 - Revenue units are missing

Please note that there are other edits that are currently WARNINGS that will become FATAL with the submission of July-September discharge information. This notice only refers to the 3 edits listed above. To see the other edits that will become fatal, scroll down to the April 8th entry entitled "Warning edits that will become FATAL edits with Q3 09 discharges".


EDITS that will remain as WARNINGS - April 15th, 2009

Recently a list of Warning edits that are scheduled to become FATAL edits with the reporting of 3rd quarter 2009 data was sent to the contacts in each hospital. There were 2 edits on that list that were indicated to become "Fatal but Verify" edits that will need to REMAIN AS WARNINGS until further notice. These 2 edits are #2505 and #2506 (see below). "Fatal but Verify" edits are flagged as fatal errors but if the hospital reviews and verifies the information to be correct as reported, the hospital can indicate this verification in the 'Enter Corrections' module on the HIDI website and the fatal error flag will be removed.

  • Edit #2505: Patient type is inpatient, but total charges are less than $150 or more than $30,000 per day.
  • Edit #2506: Patient type is outpatient, but total charges are less than $40 or more than $30,000.

Upon review of the Jan-Sept 2008 data, it was determined that if these 2 edits were made "Fatal but Verify" edits, too many records would have to be manually verified in order to remove the fatal error flags caused by the charge limits in these edits. THA will continue to work with the Department of Health to better define the upper and lower charge limits used in these edits. Until that time, these edits will remain as Warnings.

Please contact Jean Young at 615.401.7429 if you have any questions.


Warning edits that will become FATAL edits with Q3 09 discharges - April 8th, 2009

This list of Warning edits will become FATAL edits with the processing of July-September 2009 discharges. These 3rd quarter 2009 discharges are due to be submitted no later than November 29, 2009.

HIDI will begin printing these edits in blue print on the error summary/error detail reports if the rate is more than 2%. This blue print will indicate that these are conditions that will soon be FATAL errors and they need to be looked at by the hospitals and/or their data vendors BEFORE the 3rd quarter 2009 discharge data is submitted.

Some of these new fatal edits will become “Fatal but Verify” edits. This means that the record is considered to have a fatal error but if the hospital verifies that the data related to the error condition is correct as reported, the hospital will be able to indicate this on the HIDI online website. Based on this verification, the fatal flag due to this error condition will be removed. Some of these edit conditions are identified in the Medicare Code Edits as incorrect but in reality they may represent true conditions.

For example, the error message ‘Age is less than 15 and principal diagnosis is appropriate for adults only’ is flagged as a Fatal error. A review of the medical record verifies that the data of birth and principal diagnosis are reported correctly. The hospital will be able to verify that the data -- although it may look incorrect -- is correct as reported based on the information documented in the medical record.

If you have questions about this information, contact Jean Young at 615.401.7429


Unknown codes for Accident fields in UB discharge data - March 23rd, 2009

The Department of Health has added the following codes to allow for 'unknowns' to be reported in the ACCIDENT CODE, ACCIDENT STATE, and ACCIDENT DATE fields.

IF ACCIDENT CODE is 01-05 but ACCIDENT STATE and/or ACCIDENT DATE are unknown:

  • IF the ACCIDENT STATE is unknown, report Accident State as ‘XX’.
  • IF the complete ACCIDENT DATE is unknown, report Accident Date as ‘9999999999’.
  • IF only the accident day is unknown, report the month (01-12) and the 4-digit year and report the day as ‘99’ (i.e., 04992008).
  • IF the month and day are unknown, report month and day as ‘9999’ and provide the 4-digit year (i.e., 99992008).

IF there is an accident but the exact ACCIDENT CODE is unknown (i.e., can’t determine between Accident Code 01 and Accident Code 03), report Accident Code as ‘99’. In these rare cases, the Accident State and Accident Dates should be known.


Valid payer codes for 2009 UB discharge reporting - March 2nd, 2009

Due to the substantial changes in the TennCare MCOs and the Department's limit on the use of payer codes "T" (TennCare NOS) and payer code "O" (Other, unknown) in the 2009 data, click here for an updated list of valid payer codes to be used in the 2009 discharges submitted for state reporting. This list does not add any new payer codes; rather, it reflects several old payer codes that are no longer valid. Contact Jean Young if you have any questions concerning this information.


Changes in TennCare MCOs - January 2009 - December 18th, 2008

Please make those involved in UB reporting in your hospital aware of the following information as it relates to the use of payer codes in the UB data -- specifically the TennCare MCO payer codes. The State has reduced the number of TennCare MCOs that will operate in the 3 regions of the State.

The health plans will assume responsibility for physical health, mental health and substance abuse services for TennCare enrollees. Instead of having a health plan for physical health (MCO) and a different one for mental health and substance abuse services (BHO), enrollees will have one plan. The new, integrated health plans will help enrollees get both medical and behavioral healthcare through the MCO.

  • For residents in Middle TN as of April 1, 2007, only the following TennCare MCOs are in operation:
    • Amerigroup – UB payer code ‘10’
    • Americhoice – UB payer code ‘8’
    • TennCare Select* – UB payer code ‘Q’
  • For residents in West TN as of November 1, 2008, only the following TennCare MCOs are in operation:
    • Blue Care – UB payer code ‘J’
    • Americhoice – UB payer code ‘8’
    • TennCare Select* – UB payer code ‘Q’
  • For residents in East TN as of January 1, 2009, only the following TennCare MCOs are in operation:
    • Blue Care – UB payer code ‘J’
    • Americhoice – UB payer code ‘8’
    • TennCare Select* – UB payer code ‘Q’
  • The TennCare, NOS payer code ‘T’ will continue to be allowed but for no more than 10% of the records.
  • * TennCare Select only serves special enrollee populations as assigned by TennCare. Members cannot choose TennCare Select as their MCO.

Be aware that this does not limit where a TennCare patient can go to get healthcare services. In other words, a Middle TN resident with Amerigroup coverage can be treated in a Memphis hospital, or a Memphis resident with Blue Care coverage can be treated in a Nashville hospital even though those plans aren’t in operation in those areas. Also, a hospital in one region, particularly those close to the lines, may be contracted with MCOs in another region (i.e. not the one in which they are located).

Based on the information above, the following TennCare payer codes will NO LONGER BE VALID in the reported UB data effective with discharges January 1, 2009:

  • 5 = UAHC
  • 7 = Windsor Health Plan of TN, Inc.
  • 9 = Preferred Health Partnership
  • F = TLC Family Care
  • R = Unison Health Plan
  • E = BHO, not otherwise specified
  • U = Tennessee Behavioral Health
  • X = Premier Behavioral Systems of TN

HDDS Nov 18 letter & THA HIN info related to payer codes T and O - November 18th, 2008

This letter will be mailed to all hospitals from the Hospital Discharge Data System, Tennessee Department of Health (HDDS/TDH), Tuesday, November 18, 2008. This letter covers several issues related to the data that has been reported since hospitals have begun reporting in the UB-04 format. Please share this letter with your discharge data vendor or your IT staff -- whoever programs the file that creates the state discharge data each quarter for your hospital.

This second document provides some information from THA Health Information Network (THA HIN) to hospitals about how to determine the proportion of discharge records using payer codes ‘T’ and ‘O’. The use of these payer codes are two of the issues addressed in the November 18 letter from HDDS/TDH.


Warning edits becoming Fatal edits with Q3 08 discharges - October 30th, 2008

There were a lot of new fields added to the hospital discharge reporting requirement when hospitals moved to the new UB-04 format (with July 2007 discharges). The edits on these new fields were designated as Warnings for the first 12 months of submission. After the initial 12 months, these Warning edits were scheduled to become Fatal edits. The 12-month ‘delay’ was to allow hospitals time to work out problems they had in submitting the newly required fields.

Most of the new fields were implemented with July 2007 discharges. An exception to this, Present on Admission (POA) fields weren't required by the Dept of Health until January 2008 discharges. There will also be a 12-month delay on making the POA edits Fatal (POA edits become Fatal with January 2009 discharges). (THA requested the Dept to allow some of the POA edits to remain as Warnings even after January 2009 in the cases where the diagnosis/E-code doesn't require a POA but one is provided.)

Click Here for a list of all the edits on the new fields added to the hospital discharge reporting last year. Some of these edits will remain Warnings but most will become Fatal with the Q3 2008 discharges that are due to be reported no later than November 29, 2008. As indicated on the attached list, most of the POA edits become Fatal with Q1 2009 discharges. The 'Changes' column indicates the latest changes to the edits where the Dept was willing to leave some edits as Warnings or to make some edits "Fatal but Verify" edits (the condition will flag as a fatal error but the hospital may verify the information to be correct as reported). If there is no change indicated, the edit is scheduled to become Fatal soon.

Since April of this year, HIDI has been showing these “soon to become Fatal” edits in blue print on your error summary reports if the error rate was above 2% so hospitals could address reporting problems in these fields before they became Fatal errors. 


More information on new Accident fields - Accident Code_Accident Date_Accident State - October 27th, 2008

There are three (3) new fields in the UB discharge data that deal with accidents: Accident Code, Accident State, and Accident Date.

The reporting of these new fields depend on an occurrence code 01-05 being in the UB record. Occurrence codes (01-05) are not just related to motor vehicle accidents—they apply to all accidents. This information may be used by the Department of Health in linking the discharge data to the Crash Outcomes Data Evaluation System (CODES) but this is not the only reason the Department is requiring this information.

  • If Occurrence Code = 01-05, the code should be entered in positions 183-184 of the 2538 character record as the Accident Code.
  • If the Accident Code = 01-05, the date of the accident (MMDDYYYY) should be entered in positions 185-192 as the Accident Date.
  • If the Accident Code = 01-05, the state of the accident (2 character state code) should be entered in positions 181-182 as the Accident State. The State has recently agreed to allow a code ‘ZZ’ in the Accident State field if the accident state is unknown.

Unknown physician ID numbers on Outpatient discharges - October 22nd, 2008

If you have outpatient discharges that are flagging with Fatal errors because you are missing the ProfessionCode+License number and/or the UPIN/NPI, the information below may be helpful.

If providers in your community are sending patients to your hospital for outpatient tests, lab work, or diagnostic scans (i.e., CT, MRI, PET, etc.) you may not have the provider’s ProfessionCode+License number and/or UPIN/NPI if the provider is not credentialed by or does not work at the hospital. In these cases you should use the unknown codes in the Physician fields (especially in the Attending physician field).

  • Code for unknown ProfessionCode+License Number = UK9999999999
  • Code for unknown UPIN/NPI = OTH000 (alpha OTH followed by 3 zeroes)

Remember that for every physician field that is reported both portions of the provider ID (ProfessionCode+License Number and UPIN/NPI) must have something reported even if one or both portions are reported using unknown codes.

Be aware that at some point in time, the State may put a limit on the number of records that may show these unknown codes. THA will certainly urge the Department to allow a higher rate of records to be reported with unknown physician codes on the outpatient side than is allowed on the inpatient side because there are a lot of community providers that send their patients to the hospitals for these kinds of outpatient services.


REVISED - Warning edit 3709 - No accommodation revenue code for inpatients - REV CODE RANGE REVISED! - September 29th, 2008

Please notice if you have WARNING edit # 3709 on your INPATIENT error reports from HIDI! The error message presented with this edit is “No accommodation revenue code for inpatient”. This Warning may indicate that some outpatient discharges were submitted in your data with an inpatient bill type. Outpatients would not have accommodation revenue codes but all inpatients should have some variation of an accommodation revenue code (010X-021X).

If you see this error message, you should correct the error even though it is a Warning.

  • If the record is an outpatient that has been submitted in the inpatient data file, it should be deleted from the inpatient file and added to the outpatient file with the correct bill type.
  • If the record is truly an inpatient record, the accommodation revenue code needs to be added to the inpatient record so charges for all inpatients will be more reliable.
  • Corrections of this error may require resubmitting the data with corrected information if the number of records affected is too large.

The State may change this Warning to a Fatal error if problems continue to exist in the data being submitted by some hospitals. Please look at all edits carefully when you review your HIDI reports each time data is submitted. Normally Warnings do not require correction, but there are some Warning conditions that are more critical than others because they affect the overall validity of the data that is being submitted.


Importance of reporting correct NPI in UB discharge data! - September 8th, 2008

Because the Present on Admission (POA) edits are becoming Fatal errors soon (with the January 2009 discharges), hospitals need to be aware of the new information below:

CMS does not require POA indicators from hospitals that are not paid based on the inpatient prospective payment system (IPPS).

  • 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.
  • This requirement also excludes patients seen in rehabilitation and/or psych distinct part units within an acute care hospital.

The TN Dept of Health originally indicated that POA information would be required on all discharges from all hospitals. However, the State has recently decided to only require POA information on the discharges from acute care hospitals. Furthermore, if an acute care hospital has a psych or rehab distinct part unit, discharges from these distinct part units are also excluded from the POA reporting requirement.

THA will provide HIDI with a list of facilities that are critical access hospitals, cancer hospitals, long term care hospitals, pediatric hospitals, psychiatric hospitals and rehabilitation hospitals so the POA edits can be waived for them. However, for HIDI to be able to waive the POA edits for patients seen in your rehab and/or psych distinct part units, we must be able to identify these discharges within the discharge data you submit.

The new UB-04 format requires the hospital's NPI be reported in positions 1497-1511 in each 2538-character record submitted. It is very important that the NPI reported in these positions accurately reflect the NPI for the distinct part unit where the patient was treated. If your hospital has a psych or a rehab distinct part unit, the discharges from these units should report the NPI for that unit (i.e., records for patients seen in the psych unit would show the psych NPI in positions 1497-1511; records for patients seen in the rehab unit would show the rehab NPI in these positions, and all other records seen for acute care would show the acute care NPI for the hospital in these positions). Failure to do this may result in high fatal error rates when the POA errors become fatal errors and subsequent delays in being able to submit your discharge data to the TN Dept of Health.

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. THA staff will be contacting each hospital soon to verify the NPIs that may be submitted in your discharge data. We will provide this information to HIDI to use in editing the POA data.


Do Not Resuscitate - DNR - Clarification for UB-04 discharge reporting - July 21st, 2008

Information on new field, Do Not Resuscitate (DNR):

Do Not Resuscitate (DNR) is a new UB-04 field and it should be reported on ALL discharges (inpatient AND outpatient) reported to the Department of Health. This field is captured in position 180 of the 2538-character record.

The valid codes for this field are ‘Y’ or ‘N’. If any Condition Code field (Form Locators 18-28 on the UB-04 billing form) contains a “P1”, this field should be reported as ‘Y’ (yes). Otherwise, report this field as ‘N’ (no).

The current edit on this new field is a Warning however, it will become a Fatal edit with the submission of Q3 08 discharges.


New Field Information - Admit Hour - July 14th, 2008

Admit Hour is a new UB-04 field and it should be reported on all inpatient discharges reported to the Department of Health. This field is captured in positions 172-173 of the 2538-character record. The valid codes for Admit Hour are 00-23, 99, or blank. Use code 99 (unknown) if the discharge is an inpatient discharge and you do not know the Admit Hour. This field should be left blank only if the discharge is an outpatient record (these patients are not admitted for inpatient services so this field is not applicable).

The current edit on this new field is a Warning however, it will become a Fatal edit with the submission of Q3 08 discharges.

Code Definition
00 12 Midnight – 12:59 am
01 1:00 – 1:59 am
02 2:00 – 2:59 am
03 3:00 – 3:59 am
04 4:00 – 4:59 am
05 5:00 – 5:59 am
06 6:00 – 6:59 am
07 7:00 – 7:59 am
08 8:00 – 8:59 am
09 9:00 – 9:59 am
10 10:00 – 10:59 am
11 11:00 – 11:59 am
12 12 Noon – 12:59 pm
13 1:00 – 1:59 pm
14 2:00 – 2:59 pm
15 3:00 – 3:59 pm
16 4:00 – 4:59 pm
17 5:00 – 5:59 pm
18 6:00 – 6:59 pm
19 7:00 – 7:59 pm
20 8:00 – 8:59 pm
21 9:00 – 9:59 pm
22 10:00 – 10:59 pm
23 11:00 – 11:59 pm
99 Inpatient admission but admit hour unknown.
Blank Record is not an inpatient discharge.

New HIDI processing report - Verification Report - June 5th, 2008

Each THA member hospital submits discharge data quarterly through the Hospital Industry Data Institute (HIDI) secure website to meet the requirements of the state discharge reporting mandate. Once the data has been processed by HIDI, each hospital receives an email from HIDI indicating that the data has been processed and the processing reports are ready to be viewed. HIDI generates several reports each quarter for each hospital when the data are processed: Load Summary Reports, Edit Detail Reports (including edit summary information), and Validation Reports. These reports are made available to you by accessing the same website the hospital uses to submit the data (use the Download Reports feature). Each hospital should have someone reviewing these reports each quarter to make sure that the data submitted and processed for your hospital looks complete and, of even more importance, that the data looks reasonable for your hospital’s experience. Click here for a brief overview of each of these reports.

We have recently added a new report and this report should also be reviewed by each hospital each quarter. This Verification Report looks at four (4) key indicators of each hospital’s data to ensure that the data reported is complete and consistent over time.

  1. The 1st indicator is the Fatal Error Rate for inpatients and outpatients. The inpatient and outpatient fatal error rates must be no more than 2% each quarter to be accepted by the Tennessee Department of Health. (To identify specific records with fatal errors, hospitals would access the Edit Detail reports on the HIDI website.)
  2. The 2nd indicator is the Total Charges for inpatients and outpatients by quarter.
    Do these IP and OP charges look reasonable and consistent for each quarter when compared to previous quarters? If there are major increases or decreases in total charges over the year, can these increases/decreases be explained (i.e., opened a new service line or closed a service line, or updated charges in charge master)?
  3. The 3rd indicator shows the distribution of Patient Types for inpatients and outpatients by month for the current year and the previous year. Do the numbers reported by patient type look reasonable and consistent over time? If there are major increases or decreases over the year in any of the patient type categories, can these increases/decreases be explained? For example, if the ambulatory surgery numbers show a large increase from one month to the next, did the hospital add a new surgeon during that month that is bringing additional cases to the hospital?
  4. The 4th indicator shows the distribution by Payer Group for inpatients and outpatients by month for the current year and the previous year. Do the numbers reported by payer group look reasonable and consistent over time? If there are major increases or decreases in payer groups over the year, can these increases/decreases be explained? For example, if the Blue Cross numbers show a major decrease in one quarter, did your hospital’s contract with Blue Cross get changed at that time, reducing the number of Blue Cross patients you would see?

These are the types of data issues the Tennessee Department of Health will come back to THA to question if there are inconsistencies. We would prefer addressing (and documenting) these situations at the time the data is submitted rather than 6-24 months later when the Department finds them, but we need your help to do this. If we send you an email asking you to verify what may look to be inconsistent data, please let us hear back from you. If you look at the information and feel that it is accurate, tell us and we will document that you have verified the information and we will move on. Often these queries have accurately identified problems in a hospital's data submission that the hospital wanted to correct. Remember: this data will eventually be public so it is important that it be as accurate as possible.


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 >>>