Transcript HCUP National Data Standards Project

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
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.
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
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
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
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
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.
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
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•
•
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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
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
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
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•
•
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.
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-9CM procedure codes
– Loops added to report Operating and Other Operating
Physicians for each HCPC / CPT4 code reported (Line
level versus Claim Level Support)
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.
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
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
Bob Davis
Health Data Standards Consultant
[email protected]
518-456-1735