12VAC5-217-100. Late charge.

Chapter 217. Regulations of the Patient Level Data System

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 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 that fulfill the requirements specified in 12VAC5-217-15.

Statutory Authority

§§ 32.1-12 and 32.1-276.6 of the Code of Virginia.

Historical Notes

Former 12VAC25-40-10 derived from VR370-01-003 § 1.1, eff. April 1, 1994; amended and adopted as 12VAC5-217-10, Virginia Register Volume 13, Issue 22, eff. August 20, 1997; Errata, 13:25 VA.R. 3420, 3421 September 1, 1997; amended, Virginia Register Volume 32, Issue 8, eff. February 1, 2016.

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.

Statutory Authority

§§ 32.1-12 and 32.1-276.6 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 32, Issue 8, eff. February 1, 2016.

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 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 Uniform Billing Form located in the latest publication of the Uniform Billing Manual prepared by the National Uniform Billing Committee. 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 provides a detailed field description and any special instruction pertaining to that element. An asterisk (*) indicates when the required data element is either not on the billing form or in the Uniform Billing Manual. The instructions provided under that particular data element should then be followed. 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

1. Hospital identifier.*
Enter the six-digit Medicare provider number or a number assigned by the board or its designee.

2. Attending physician identifier.
Enter the nationally assigned physician identification number, either the Uniform Physician Identification Number (UPIN) or National Provider Identifier (NPI) as approved by the board for the physician assigned as the attending physician for an inpatient.

3. Other physician identifier.
Enter the nationally assigned physician identification number, either the Uniform Physician Identification Number (UPIN) or National Provider Identifier (NPI) as approved by the board for the physician identified as the operating physician for the principal procedure reported.

4. Payor identifier.

5. Employer identifier.

6. Patient identifier.*
Enter the nine-digit social security number of the patient. If a social security number has not been assigned, leave blank. The nine-digit social security number is not required for patients under four years of age.

7a. Patient sex.

7b. Race code.*
If an inpatient hospital collects information regarding the choices listed below, the appropriate one-digit code reflecting the race of the patient should be entered. If a hospital only collects information for categories 0, 1, or 2, then the appropriate code should be entered from those three selections.

0 = White

1 = Black

2 = Other

3 = Asian

4 = American Indian

5 = White Hispanic

6 = Black Hispanic

7c. Date of birth.

7d. Street address, city or county, and zip code.

7e. Employment status code.

7f. Patient status (i.e., discharge).
Inpatient codes only.

7g. Birth weight (for infants).*
Enter the birth weight of newborns in grams.

8a. Admission type.

8b. Admission source.

8c. Admission date.

8d. Admission hour.

8e. Admission diagnosis code.

9a. Discharge date.
Only enter date of discharge.

10. Principal diagnosis code.
Enter secondary diagnoses (up to eight).
In addition, include diagnoses recorded in the comments section for DX6-DX9.

11. External cause of injury code (E-code).
Record all external cause of injury codes in secondary diagnoses position after recording all treated secondary diagnoses.

12. Co-morbid conditions existing but not treated.

13. Principal procedure code and date.
Enter other procedures and dates (up to five). In addition, include procedures recorded in the comments section for PX4-PX6.

14. Revenue code (up to 23).
Units of service (up to 23).
Units of service charges (up to 23).

15. Total charges (by revenue code category or by HCPCS code).
(R.C. Code 001 is for total charges. See page 47-1.)

Statutory Authority

§§ 32.1-12 and 32.1-276.6 of the Code of Virginia.

Historical Notes

Former 12VAC25-40-20 derived from VR370-01-003 § 2.1, eff. April 1, 1994; amended and adopted as 12VAC5-217-20, Virginia Register Volume 13, Issue 22, eff. August 20, 1997; Volume 32, Issue 8, eff. February 1, 2016.

12VAC5-217-30. (Repealed.)

Historical Notes

Former 12VAC25-40-30 derived from VR370-01-003 § 3.1, eff. April 1, 1994; amended and adopted as 12VAC5-217-30, Virginia Register Volume 13, Issue 22, eff. August 20, 1997; repealed, Virginia Register Volume 32, Issue 8, eff. February 1, 2016.

12VAC5-217-40. Options for submission.

Each inpatient hospital shall submit the patient level data to the board for processing and verification. If data is submitted in this fashion, the board will transmit it to the nonprofit organization along with any fees submitted by the hospital to the board for the processing and verification of such data.

As an alternative to submitting the patient level data to the board, an inpatient hospital may submit the patient level data to the office of the nonprofit organization for processing and verification.

If a hospital chooses this alternative it shall notify the board and the nonprofit organization of its intent to follow this procedure.

In lieu of submitting the patient level data to the board or to the nonprofit organization, an inpatient hospital may submit already processed, verified data to the nonprofit organization. If an inpatient hospital chooses this alternative for submission of patient level data, it shall notify the board and the nonprofit organization of its intent to utilize this procedure.

If an inpatient hospital decides to change the option it has chosen, it shall notify the board of its decision 30 days prior to the due date for the next submission of patient level data.

Statutory Authority

§§ 32.1-12 and 32.1-276.2 of the Code of Virginia.

Historical Notes

Former 12VAC25-40-40 derived from VR370-01-003 § 4.1, eff. April 1, 1994; amended and adopted as 12VAC5-217-40, Virginia Register Volume 13, Issue 22, eff. August 20, 1997.

12VAC5-217-50. Contact person.

Each hospital shall notify in writing the board and the nonprofit organization of the name, address, telephone number and fax number of a contact person. If a hospital's contact person changes, the board and the nonprofit organization shall be notified in writing as soon as possible of the name of the new person who shall be the contact person for that hospital.

Statutory Authority

§§ 32.1-12 and 32.1-276.2 of the Code of Virginia.

Historical Notes

Former 12VAC25-40-50 derived from VR370-01-003 § 4.2, eff. April 1, 1994; amended and adopted as 12VAC5-217-50, Virginia Register Volume 13, Issue 22, eff. August 20, 1997.

12VAC5-217-60. Frequency of submission.

A. Inpatient hospitals shall submit patient level data for inpatients at least on a calendar year quarterly basis.

B. If the data is submitted to the board or to the nonprofit organization for processing and verification, it shall be received at the office of the board or the office of the nonprofit organization within 45 days after the end of each calendar year quarter.

C. If inpatient hospitals choose to submit processed, verified data directly to the nonprofit organization, it shall be received at the office of the nonprofit organization within 120 days after the end of each calendar year quarter.

Statutory Authority

§§ 32.1-12 and 32.1-276.2 of the Code of Virginia.

Historical Notes

Former 12VAC25-40-60 derived from VR370-01-003 § 4.3, eff. April 1, 1994; amended and adopted as 12VAC5-217-60, Virginia Register Volume 13, Issue 22, eff. August 20, 1997.

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.

Statutory Authority

§§ 32.1-12 and 32.1-276.6 of the Code of Virginia.

Historical Notes

Former 12VAC25-40-70 derived from VR370-01-003 § 5.1, eff. April 1, 1994; amended and adopted as 12VAC5-217-70, Virginia Register Volume 13, Issue 22, eff. August 20, 1997; Volume 32, Issue 8, eff. February 1, 2016.

12VAC5-217-80. (Repealed.)

Historical Notes

Former 12VAC25-40-80 derived from VR370-01-003 § 5.2, eff. April 1, 1994; amended and adopted as 12VAC5-217-80, Virginia Register Volume 13, Issue 22, eff. August 20, 1997; repealed, Virginia Register Volume 32, Issue 8, eff. February 1, 2016.

12VAC5-217-90. (Repealed.)

Historical Notes

Former 12VAC25-40-90 derived from VR370-01-003 § 5.3, eff. April 1, 1994; amended and adopted as 12VAC5-217-90, Virginia Register Volume 13, Issue 22, eff. August 20, 1997; repealed, Virginia Register Volume 32, Issue 8, eff. February 1, 2016.

12VAC5-217-100. Late charge.

A late charge of $25 per working day shall be paid to the board by an inpatient hospital that does not submit, in aggregate, a complete filing of the patient level data required by 12VAC5-217-20 for all inpatients discharged in a calendar year quarter pursuant to the times established in 12VAC5-217-60. This requirement may be waived by the board if an inpatient hospital can show that an extenuating circumstance exists. Examples of an extenuating circumstance include, but are not limited to, the installation of a new computerized billing system, a bankruptcy proceeding, closure of the institution, change of ownership in the institution, or the institution is a new facility that has recently opened.

Statutory Authority

§§ 32.1-12 and 32.1-276.2 of the Code of Virginia.

Historical Notes

Former 12VAC25-40-100 derived from VR370-01-003 § 5.4, eff. April 1, 1994; amended and adopted as 12VAC5-217-100, Virginia Register Volume 13, Issue 22, eff. August 20, 1997.

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