Health Care Service Data Reporting Guide Informational Session Friday, September 23, :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 Discover the background of the Health Care Service: Data Reporting Guide Discover the background of the Health Care Service: Data Reporting Guide Understand the process of developing the guide; Understand the process of developing the guide; Obtain a summary of enhancements for the latest version (5010) of the guide; and 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 Identify next steps to implement the guide and contribute towards future versions and enhancements Session Objective: learn what the guide has to offer to public health reporting systems

Guide Background Health Care Service Data Reporting Guide (HCSDRG) 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 Institutional Claim Professional Claim Professional Claim Dental Claim Dental Claim

Development Process Level setting for ANSI ASC X12 terminology 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) 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 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 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 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 Data Maintenance – more substantial changes Code Maintenance Requests (CMR) – for maintenance of ANSI ASC X12 maintained code lists 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 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 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 Situational Notes aligned Examples aligned Examples aligned Segment Notes aligned Segment Notes aligned Common Front Matter aligned Common Front Matter aligned –Closer coordination with Data Content Committees (NUBC, NUCC, & DeCC) –Goal make all ANSI ASC X 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 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 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 Attending Physician Operating Physician Operating Physician Other Operating Physician – replaces Other Provider Loop in current versions Other Operating Physician – replaces Other Provider Loop in current versions Rendering Provider – 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 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. 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 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 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 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)

Summary of Highlights in 5010 Version of HCSDRG Reminder of current of some special business needs also accommodated in this version of the 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 Now called the Standards for Classification of Federal Data on Race and Ethnicity Maintained by Centers for Disease Control and Prevention 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 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 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. 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 Educational Materials related to the HCSDRG and the ANSI ASC X12 standards –On the Public Health Data Standards Consortium (PHDSC) web site –On the National Association of Health Data Organization (NAHDO) web site – –On the ANSI ASC X12 web site – –On the NUBC web site –

Next Steps –Be proactive – Be part of process – subscribe to PHDSC & NAHDO listservs –Possible topics for next session implementation issues 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 Next set of enhancements needed in the next version of the guide Relationship to the Claims Attachment process Relationship to the Claims Attachment process

Bob Davis Health Data Standards Consultant