Proposed Text
12VAC5-217-10. Definitions.
The following words and terms, when used in this chapter, shall have the following meanings:
"Board" means the Virginia Board of Health.
"Complete filing" means that patient level data of at least 99% of a hospital's inpatient discharges for a calendar year quarter are submitted.
"Inpatient hospital" means a hospital providing
inpatient care and licensed pursuant to Article 1 (§ 32.1-123 et seq.) of
Chapter 5 of Title 32.1 of the Code of Virginia, a hospital licensed pursuant
to Chapter 8 (§ 37.1-179 et seq.) of Title 37.1 Article 2 (§ 37.2-403
et seq.) of Chapter 4 of Title 37.2 of the Code of Virginia, a hospital
operated by the Department of Behavioral Health and Developmental Services for
the care and treatment of individuals with mental illness, or a hospital
operated by the University of Virginia or Virginia Commonwealth University Health
System Authority.
"Nonprofit organization" means a nonprofit, tax-exempt health data organization with the characteristics, expertise, and capacity to execute the powers and duties set forth for such entity in Chapter 7.2 (§ 32.1-276.2 et seq.) of Title 32.1 of the Code of Virginia and with which the Commissioner of Health has entered into a contract as required by § 32.1-276.4 of the Code of Virginia.
"Processed, verified data" means data on inpatient
records which have been subjected to edits that fulfill the
requirements specified in 12VAC5-217-15. These edits shall be applied to
data elements which are on the UB-92 Billing Form (or a successor Billing Form
adopted by the Virginia Uniform Billing Committee for use by inpatient
hospitals in Virginia). The edits shall have been agreed to by the board and
the nonprofit organization. Inpatient records containing invalid UB-92 codes or
all blank fields for any of the data elements subjected to edits shall be
designated as error records. To be considered processed and verified, a
complete filing of all records which are submitted by an inpatient hospital in
aggregate per calendar year quarter and which are subjected to these edits must
be free of error at a prescribed minimum rate. The prescribed minimum error
rate shall be 95% overall, with patient identifier separately calculated at 95%
or a minimum rate recommended by the board of directors of the nonprofit
organization and approved by the Virginia Board of Health. The error rate shall
be calculated on only those fields designated in 12VAC5-217-20 or as
subsequently approved by the board through the process specified in
12VAC5-217-20.
"System" means the Virginia Patient Level Data
System.
12VAC5-217-15. Requirements of processed, verified data.
Inpatient hospitals shall submit only processed, verified data from inpatient records. To be considered processed and verified, a complete filing of all records that are submitted by an inpatient hospital in aggregate per calendar year quarter must be free of error at a prescribed minimum rate. The prescribed minimum accuracy rate shall be 95% overall, with patient identifier separately calculated at 95%. The accuracy rate shall be calculated on only those fields designated in 12VAC5-217-20. Inpatient records containing invalid codes or blank fields for any of the data elements shall be designated as error records.
12VAC5-217-20. Reporting requirements for patient level data elements.
Every inpatient hospital shall submit a complete filing of
each patient level data element listed below in the table in this
section for each hospital inpatient, including a separate record for each
infant, if applicable. Most of these data elements are currently collected from
a UB-92 Uniform Billing Form located in the latest publication
of the Uniform Billing Manual prepared by the National Uniform Billing
Committee. The column for a "Form Locator" indicates where the
data element is located on the UB-92. For elements collected on the UB-92, the
column "Page Number" refers to the Uniform Billing Manual (UB-92),
revised May, 1993. The Uniform Billing Form and the Uniform Billing
Manual are located on the National Uniform Billing Committee's website at www.nubc.org. The Uniform Billing Manual UB-92,
prepared for Virginia hospitals by the Virginia Uniform Billing Committee,
provides a detailed field description and any special instructions instruction
pertaining to that element. An asterisk (*) indicates when the required data
element is either not on the UB-92 billing form or in the Uniform
Billing Manual. The instructions provided under that particular data element
should then be followed. If a successor billing form to the UB-92 form is
adopted by the Virginia Uniform Billing Committee for use by inpatient
hospitals in Virginia, information pertaining to the data elements listed below
should be derived from that successor billing form. Inpatient hospitals
that submit patient level data directly to the board or the nonprofit
organization shall submit it in an electronic data format.
Data Element |
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1. Hospital identifier.* |
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2. Attending physician identifier. |
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3. Other physician identifier. |
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4. Payor identifier. |
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5. Employer |
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6. Patient identifier.* |
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7a. Patient sex. |
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7b. Race code.* |
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0 = White |
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1 = Black |
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2 = Other |
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3 = Asian |
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4 = American Indian |
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5 = White Hispanic |
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6 = Black Hispanic |
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7c. Date of birth. |
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7d. |
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8a. Admission type. |
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8b. Admission source. |
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8c. Admission date. |
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8d. Admission hour. |
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8e. Admission diagnosis code. |
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9a. Discharge date. |
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10. Principal diagnosis code. |
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11. External cause of injury code (E-code). |
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12. Co-morbid conditions existing but not treated. |
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12VAC5-217-30. Options for filing format. (Repealed.)
Inpatient hospitals of 100 beds or more that submit patient
level data directly to the board or the nonprofit organization shall submit it
in an electronic data format. Hospitals of less than 100 beds that submit
patient level data directly to the board or the nonprofit organization may
directly submit it in electronic data format or in hard copy. If hard copy is
utilized the hospital shall submit, for each inpatient discharged, a copy of
the UB-92 and an addendum sheet for those data elements not collected on the
UB-92 or defined in the Uniform Billing Manual. These hospitals must submit all
patient level data in electronic data format by January 1, 1995.
If a hospital submits processed, verified data directly to
the nonprofit organization, it shall be in electronic format.
12VAC5-217-70. Establishment of annual fee.
The board shall not assess any fee against any health care
provider that submits data under this chapter that is processed, verified, and
timely in accordance with standards established by the board. The board shall
prescribe a reasonable fee not to exceed $1.00 per discharge for each inpatient
hospital submitting patient level data pursuant to this chapter that is not
processed, verified, or timely to cover the cost of the reasonable expenses
in processing and verifying such data. The fee shall be established and
reviewed annually by the board. Payment of the fee by a hospital shall be at
the time quarterly inpatient data is submitted.
12VAC5-217-80. Payment of fee to nonprofit organization. (Repealed.)
If an inpatient hospital chooses to submit its patient
level data directly to the nonprofit organization, that hospital may pay the
fee described in 12VAC5-217-70 to the nonprofit organization at the time it
submits its quarterly data. If a hospital pays its fee directly to the
nonprofit organization, the requirements of a fee to be paid to the board, as
described in 12VAC5-217-70, shall be waived by the board.
12VAC5-217-90. Waiver or reduction of fee. (Repealed.)
If a hospital submits processed, verified patient level
data to the nonprofit organization, the nonprofit organization may, in its
discretion, grant a waiver or reduction of the fee if it determines that the
hospital has submitted properly processed, verified data.