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.

Each inpatient hospital shall submit, in an electronic data format, 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.

Table 1

Data Element

1. Provider Number
Enter the Medicare Provider Number

2. Provider NPI

3. Patient Control Number

4. Discharge Date
Discharge Statement Covers Period Through Date in MMDDYYYY format

5. Patient Zip Code
Zip Code of Patient Address

6. Patient Date of Birth
Date in MMDDYYYY format

7. Patient Sex
M, F, or U

8. Admission Date and Hour
Date in MMDDYYYY format, hour of admission in military time

9. Admission Type

10. Admission Source

11. Patient Discharge Status

12. Medical Record Number

13. Revenue Center Code (up to 22)

14. Revenue Center Units (up to 22)

15. Revenue Center Charges (up to 22)
Dollars and cents with an implied decimal

16. Total Charges
Dollars and cents with an implied decimal. If greater than $999,999.99, then use 99999999

17. Payor Identifier (up to 3)
Enter the Board of Health approved payor designation, which will be the nationally assigned payor ID, its successor, or English description of the payor

18. Patient Relationship to Insured A

19. Patient Social Security Number (SSN)
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

20. Employment Status Code
Use the following codes
1 = Employed Full Time
2 = Employed Part Time
3 = Not Employed
4 = Self-employed
5 = Retired
6 = On Active Military Duty
9 = Unknown

21. Employer Identifier
Enter the federally approved EIN, or employer name

22. Principal Diagnosis Code
Codes set ICD-10 or their successors, omit decimal; eighth character is the Present On Admission value (Y, N, U, W, or 1)

23. Other Diagnosis Code (up to 17)
Codes set ICD-10 or their successors, omit decimal; eighth character is the Present On Admission value (Y, N, U, W, or 1)

24. Admitting Diagnosis Code
Codes set ICD-10 or their successors, omit decimal, eighth character is the Present On Admission value (Y, N, U, W, or 1)

25. External Cause of Injury Code (up to 3)
Codes set ICD-10 or their successors, omit decimal; eighth character is the Present On Admission value (Y, N, U, W, or 1)

26. Principal Procedure Code
Codes set ICD-10 or their successors, omit decimal

27. Principal Procedure Date
Date in MMDDYY format

28. Other Procedure Codes (up to 5)
Codes set ICD-10 or their successors, omit decimal

29. Other Procedure Dates (up to 5)
Date in MMDDYY format

30. Attending Physician
Physician's Individual NPI

31. Operating Physician
Physician's Individual NPI

32. Other Physician Provider (up to 2)
Physician's Individual NPI

33. Infant Birth Weight (in grams)

34. Patient Race
Use the following codes:
0 = White
1 = Black
2 = Other, specified
3 = Asian
4 = American Indian
5 = Hispanic - White
6 = Hispanic - Black
9 = Unknown, not recorded

35. Patient Street Address
Enter the valid patent's residence street number and street name. Do not include P.O. Box numbers

36. Patient City or County
Enter the valid patient's complete City or County of residence

37. Patient Legal Status
Enter the legal status of a psychiatric admission:
1 = § 16.1-338 Parental admission of minors younger than 14 and nonobjecting minors 14 years of age or older
2 = § 16.1-339 Parental admission of objecting minor 14 years of age or older
3 = § 16.1-340.1 Involuntary temporary detention order of a minor
4 = § 16.1-345 Involuntary commitment of a minor
5 = § 37.2-805 Voluntary admission of an adult
6 = § 37.2-809 Involuntary temporary detention order of an adult
7 = § 37.2-904 Sexually violent predator

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; amended, Virginia Register Volume 32, Issue 8, eff. February 1, 2016; Volume 42, Issue 14, eff. April 9, 2026.

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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