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Health Care Service Data Reporting Guide Informational Session

Health Care Service Data Reporting Guide Informational Session. Friday, September 23, 2005 1:00 pm – 2:30 pm Presented by Bob Davis. Purpose of Guide. This guide seeks to promote less variability by improving data comparability and data integrity across state and federal reporting

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Health Care Service Data Reporting Guide Informational Session

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  1. Health Care Service Data Reporting Guide Informational Session Friday, September 23, 2005 1:00 pm – 2:30 pm Presented by Bob Davis

  2. Purpose of Guide This guide seeks to promote less variability by improving data comparability and data integrity across state and federal reporting systems. Using a standard will enable state and federal reporting systems to decrease variability across public agencies as well as improving multi-state reporting and collection of administrative data.

  3. Agenda Session Objective: learn what the guide has to offer to public health reporting systems • Discover the background of the Health Care Service: Data Reporting Guide • Understand the process of developing the guide; • Obtain a summary of enhancements for the latest version (5010) of the guide; and • Identify next steps to implement the guide and contribute towards future versions and enhancements

  4. Guide Background • Health Care Service Data Reporting Guide (HCSDRG) • A subset of the 837 ANSI ASC X12 Standard • Developed and maintained as part of the ANSI ASC X12 Insurance (N) Health Care Task Group (TG2) Claims Work Group (WG2) • Approval needed by ANSI ASC X12 before publication as a standard for a particular version • Sister Guides • Institutional Claim • Professional Claim • Dental Claim

  5. Development Process • Level setting for ANSI ASC X12 terminology • ANSI ASC X12 Standard - • The bible – this includes the details of the parts (segments and data elements and transaction sets) • What is in these segments and data elements and transaction sets based on a well defined business need. (note some parts of the standard are used by all industries [ie name and address segments] and some parts are used only by one particular industry [ie health information segments] • If the needs change over time so must the standards • Implementation Guides • a subset of the standard containing the detailed rules [ie required versus situational] to implement a particular version of one of the standard transaction sets for a specific purpose [ie state reporting functions

  6. Development Process • Level setting for ANSI ASC X12 terminology • ANSI ASC X12 Versions - • numbering scheme to designate when changes to the ANSI ASC X12 standard are made – Note changes to X12 standards are NOT retroactive • 4010 – changes to the standard made prior to October 1997 • 4050 – changes to the standard made prior to October 2001 • 5010 – changes to the standard made prior to October 2003 • Changes are made to the standard by • Data Maintenance – more substantial changes • Code Maintenance Requests (CMR) – for maintenance of ANSI ASC X12 maintained code lists

  7. Development Process • Highlight Claims Work Group (ANSI ASC X12N TG2 WG2) Activities • Public comment period ended on March 26, 2005 for 5010 Version (October 2003) of 837 Implementation Guides (Institutional, Professional, Dental, & Reporting) • Currently working on incorporating the more than 2500 comments into all the guides • ANSI ASC X12 Vote for acceptance of 5010 Implementation Guides as a Standard expected in Spring 2006.

  8. Summary of Highlights in 5010 Version of HCSDRG • Highlight Claims Work Group (ANSI ASC X12N TG2 WG2) Activities • Currently in development in conjunction with the 5010 versions of the institutional, professional, and dental claim implementation guides • Situational Notes aligned • Examples aligned • Segment Notes aligned • Common Front Matter aligned • Closer coordination with Data Content Committees (NUBC, NUCC, & DeCC) • Goal make all ANSI ASC X12 837 Implementation Guides more INDUSTRY FRIENDLY

  9. Summary of Highlights in 5010 Version of HCSDRG • New business needs accommodated in this version of the HCSDRG & the Institutional Claim Implementation Guide • Reporting of ICD-10-CM and ICD-10-PCS • National Provider Identifier – 10 character identifier (9 plus a check digit) • 3 “slots” allocated to report Patient’s Reason for Visit. • Separate “slot” for reporting Admitting Diagnosis • 12 “slots” allocated to report external cause of injury code

  10. Summary of Highlights in 5010 Version of HCSDRG • New business needs accommodated in this version of the HCSDRG & the Institutional Claim Implementation Guide • Change in the way Covered and Uncovered days reported using UB Value Codes • The following physician/provider types are now supported (before the choices where attending, operating, and other) • Attending Physician • Operating Physician • Other Operating Physician – replaces Other Provider Loop in current versions • Rendering Provider – replaces Other Provider Loop in current versions • Referring Provider – replaces Other Provider Loop in current versions • NOTE: After NPI is implemented these ID’s will also be reported using the 10 character national identifier.

  11. Summary of Highlights in 5010 Version of HCSDRG • New business needs accommodated in this version of the HCSDRG • Patient Marital Status – NOTE: there has also been a change in how this is supported on the proposed UB-04. • aligning reporting of procedure coding with HIPAA legislation • Inpatient ICD-9-CM procedure code reporting ONLY on claim level in HI segments • Outpatient HCPC/CPT4 procedure code reporting ONLY on service line in SV2 segments • Support added for reporting time of procedure for ICD-9-CM procedure codes • Loops added to report Operating and Other Operating Physicians for each HCPC / CPT4 code reported (Line level versus Claim Level Support)

  12. Summary of Highlights in 5010 Version of HCSDRG • Reminder of current of some special business needs also accommodated in this version of the HCSDRG • Support for reporting of Race and Ethnicity using OMB standards • Now called the Standards for Classification of Federal Data on Race and Ethnicity • Maintained by Centers for Disease Control and Prevention • Present on Admission Indicator for secondary diagnosis • Note: This data element will now also be supported in the 5010 Version of the Institutional Claim Implementation Guide • This element also being included on UB-04 • Guidelines for reporting this being developed by an NUBC work group co-chaired by Donna Pickett of NCHS and Sue Bowman of AHIMA.

  13. Summary of Highlights in 5010 Version of HCSDRG • Educational Materials related to the HCSDRG and the ANSI ASC X12 standards • On the Public Health Data Standards Consortium (PHDSC) web site - www.phdatastandards.info • http://www.phdatastandards.info/knowresources/papers/roadmap.htm • http://www.phdatastandards.info/knowresources/papers/evol_ANSI.htm • http://www.phdatastandards.info/standardsdev/dsmo/x12docs/hcs_drgt.htm • On the National Association of Health Data Organization (NAHDO) web site – www.nahdo.org • http://www.nahdo.org/project/Matrix.aspx • On the ANSI ASC X12 web site – www.x12.org • On the NUBC web site – www.nubc.org

  14. Next Steps • Be proactive – Be part of process – subscribe to PHDSC & NAHDO listservs • Possible topics for next session • implementation issues • Experiences of states already using 837 • Issues for states wanting to use 837 • Next set of enhancements needed in the next version of the guide • Relationship to the Claims Attachment process

  15. Bob Davis Health Data Standards Consultant rdavis@nahdo.org 518-456-1735

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