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

As in effect on May 1, 2012

Table of Contents

• R428-10-1. Legal Authority.
• R428-10-2. Purpose.
• R428-10-3. Definitions.
• R428-10-4. Source of Inpatient Hospital Discharge Data Reporting.
• R428-10-5. Data Submittal Schedule.
• R428-10-6. Data Element Reporting.
• R428-10-7. Exemptions, Extensions, and Waivers.
• R428-10-8. Penalties.
• KEY
• Date of Enactment or Last Substantive Amendment
• Notice of Continuation
• Authorizing, Implemented, or Interpreted Law

R428-10-1. Legal Authority.

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

R428-10-2. Purpose.

This rule establishes the reporting standards for inpatient discharge data by licensed hospitals. Inpatient discharge data are needed to develop and maintain a statewide hospital inpatient discharge data base.

R428-10-3. Definitions.

These definitions apply to rule R428-10.

(1) "Office" as defined in R428-2-3(A).

(2) "Discharge data" means the consolidation of complete billing, medical, and personal information describing a patient, the services received, and charges billed for a single inpatient hospital stay into a discharge data record.

(3) "Hospital" means a facility that is licensed under R432-100.

(4) "Level 1 data element" means a required reportable data element.

(5) "Level 2 data element" means a data element that is reported when the information is available from the patient's hospital record.

(6) "Patient Social Security number" is the social security number of the patient receiving inpatient care.

(7) "Record linkage number" is an irreversible, unique, encrypted number that will replace patient social security number. The Office assigns the number to serve as a control number for data analysis.

(8) "Uniform billing form" means the uniform billing form recommended for use by the National Uniform Billing Committee.

R428-10-4. Source of Inpatient Hospital Discharge Data Reporting.

The reporting source for hospital inpatient discharge data is Utah licensed hospitals.

(1) A hospital facility, either general acute care or specialty hospital, shall report discharge data records for each inpatient discharged from its facility.

(2) A hospital may designate an intermediary, such as the Utah Hospital Association, or may submit discharge data directly to the committee.

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

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

R428-10-5. Data Submittal Schedule.

Each hospital shall submit to the Office a single discharge data record for each patient discharged according to the schedule shown in Table 1, Hospital Discharge Data Submittal Schedule, or a schedule mutually agreed upon by the Office and hospital. For a patient with multiple discharges, each hospital shall submit a single discharge data record for each discharge. For a patient with multiple billing claims each hospital shall consolidate the multiple billings into a single discharge data record for submission after the patient's discharge.

                                                    TABLE 1
                                       HOSPITAL DISCHARGE DATA SUBMITTAL SCHEDULE

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

R428-10-6. Data Element Reporting.

Tables 2 and 3 display the reportable data elements by defined level. A hospital shall, as a minimum, report the required level 1 data elements shown in Table 2. Each hospital shall report level 2 data elements shown in Table 3 whenever the information is a part of the hospital's patient record. Beginning July 1, 1993, each patient social security number shall be reported as a level 2 (as available) data element. Beginning January 1, 1995, each hospital shall collect patient social security number as a level 1 (required) data element on the hospital discharge record, and report the patient social security number with the complete discharge record according to the submittal schedule. The Department shall adopt an encryption method to mask patient identity and replace patient social security number with a record linkage number as the control number. The Department may not retain the original record containing patient social security number and shall destroy the original record containing patient social security number after the Department assures the validity of the patient record. The Department of Health may conduct on-site audits to verify the accuracy of all submittals.

Each hospital shall submit the reported data elements on computer diskette, magnetic tape, or as an "electronic copy" of encounter or claim data, through the Utah Health Information Network or another compatible electronic data interchange network. The Office shall accept data that complies with data standards established in R590-164, Uniform Health Billing Rule. The Office shall provide to each hospital, a Hospital Inpatient Discharge Data Submittal Technical Manual which outlines the specifications, format, and types of data to report. The revised Submittal Technical Manual is effective on January 1, 1995.

                                                    TABLE 2
                                                    REQUIRED LEVEL 1
                                       HOSPITAL INPATIENT DISCHARGE DATA ELEMENTS

     CATEGORY            NAME
     Provider

     1.             Provider identifier
     Patient
     2.             Patient control number
     3.             Patient's medical chart number
     4.             Patient Social Security Number
     5.             Patient's postal zip code for address
     6.             Patient's date of birth
     7.             Patient's gender
     Service
     8.             Admission date
     9.             Type of admission
     10.            Source of admission
     11.            Patient's status
     12.            Statement covers period
     Charge
     13.            Revenue codes
     14.            Units of service
     15.            Total charges by revenue code
     Payer
     16.            Payer's identification
     17.            Patient's relationship to insured
     Diagnosis and Treatment
     18.            Principal diagnosis
     19.            Other diagnosis codes
     20.            External cause of injury code (E-code)
     21.            Principal procedure code
     22.            Other procedure codes
     23.            Procedure coding method, required
                         if coding is not ICD-9
     Physician
     24.            Attending physician ID
     25.            Other physicians' IDs
     Other
     26.            Type of bill
                                                            

                                                    TABLE 3
                                         WHEN DATA ELEMENT IS AVAILABLE FROM THE
                                                HOSPITAL'S PATIENT RECORD
                                                         LEVEL 2
                                       HOSPITAL INPATIENT DISCHARGE DATA ELEMENTS

     CATEGORY            NAME
     Patient
     1.              Patient marital status
     Payer
     2.              Insured group name
     Employer
     3.              Employment status code
     4.              Employer name
     5.              Employer location
     Charge
     6.              Prior payments
     7.              Patient Race and Ethnicity
     8.              Estimated amount due
     Payer
     9.              Certificate/Social Security Number/Health
                     Insurance Claim/Identification Number
     Physician
     10.             Resident ID
     11.             Resident ID Type
                                                            

R428-10-7. Exemptions, Extensions, and Waivers.

(1) Hospitals may submit requests for exemptions or waivers to the committee within 60 calendar days of the due date as listed in the hospital discharge data submittal schedule in R428-10-5, Table 1. Exemptions or waivers to the requirements of this rule may be granted for a maximum of one calendar year. A hospital wishing an exemption or waiver for more than one year must submit a request annually.

(2) Requests for extensions must be submitted to the Office at least ten working days prior to the due date as listed in the hospital discharge data submittal schedule. Extensions to the submittal schedule may be granted for a maximum of 30 calendar days. The hospital must separately request each additional 30 calendar day extension.

(3) The committee may grant exemptions or waivers when the hospital demonstrates that compliance imposes an unreasonable cost to the hospital. The Office may grant extensions when the hospital documents that technical or unforeseen difficulties prevent compliance. A petitioner requesting an exemption, extension, or waiver shall make the request in writing. A request for exemption, extension, or waiver must contain the following information:

(a) the petitioner's name, mailing address, telephone number, and contact person;

(b) the date the exemption, extension, or waiver is to start and end;

(c) a description of the relief sought, including reference to the specific sections of the rule;

(d) a statement of facts, reasons, or legal authority in support of the request; and

(e) a proposed alternative to the requirement.

(4) A form for exemption, extension, or waiver can be found in the technical manual available from the Office. Exemptions, extensions, or waivers may be granted for the following:

(a) Hospital exemption: All hospitals are subject to the reporting requirements. Reasons justifying an exemption might be a circumstance where the hospital makes no effort to charge any patient for service.

(b) Discharge data consolidation exemption: This exemption allows variation in the data consolidation requirement, such as allowing the hospital to submit multiple records containing the reportable data elements rather than a single consolidated discharge data record.

(c) Reportable data element exemption: Each request for a data element exemption must be made separately.

(d) Submission media exemption: This exemption allows variation in the submission media, such as a paper copy of the uniform billing form.

(e) Submittal schedule extension: The request must specifically document the technical or unforeseen difficulties that prevent compliance.

(f) Submission format waiver: This waiver allows variation in the submission format. Each request must state an alternative transfer electronic media, its format, and the record layout for the discharge data records. Granting of this waiver is dependent on the Office's ability to process the submittal media and format with available computer resources.

R428-10-8. Penalties.

Pursuant to Section 26-23-6, any person that violates any provision of this rule may be assessed an administrative civil money penalty not to exceed $3,000 upon an administrative finding of a first violation and up to $5,000 for a subsequent similar violation within two years. A person may also be subject to penalties imposed by a civil or criminal court, which may not exceed $5,000 or a class B misdemeanor for the first violation and a class A misdemeanor for any subsequent similar violation within two years.

KEY

health, hospital policy, health planning

Date of Enactment or Last Substantive Amendment

February 27, 2004

Notice of Continuation

November 30, 2011

Authorizing, Implemented, or Interpreted Law

26-33a-104; 26-33a-108