Updating the Health Care Service Data Updating the Health Care Service Data Reporting Guide (HCSDRG)Reporting Guide (HCSDRG)

WebinarWebinar

June 12, 2013June 12, 2013

Robert Davis, Standards ConsultantRobert Davis, Standards Consultant

What is the Health Care Service Data What is the Health Care Service Data Reporting Guide?Reporting Guide?

X12N standard for reporting health care services X12N standard for reporting health care services data (electronic data interchange) data (electronic data interchange)

HIPAA compatible (but not compliant)HIPAA compatible (but not compliant)

Standardized data requirements & content using Standardized data requirements & content using X12N 837 health claim transaction set standardX12N 837 health claim transaction set standard

Modeled after UB-92 Data Content Standards & Modeled after UB-92 Data Content Standards & HIPAA Institutional Claims Format Standard (837) HIPAA Institutional Claims Format Standard (837) because that is where our because that is where our data sourcedata source took us took us

Health Care Service Data Reporting Guide:Health Care Service Data Reporting Guide:Some ParticularsSome Particulars

Outreach to Public Health Community Outreach to Public Health Community facilitated by Public Health Data facilitated by Public Health Data Standards Consortium (PHDSC) reporting Standards Consortium (PHDSC) reporting guide work groupguide work group

Approved by X12N as an official work Approved by X12N as an official work product of the Healthcare Claims Work product of the Healthcare Claims Work GroupGroup

Developed in collaboration with theDeveloped in collaboration with the PHDSCPHDSC

Why is the Guide Needed?Why is the Guide Needed?

Many statewide discharge data programs Many statewide discharge data programs are planning to migrate to the X12N 837 are planning to migrate to the X12N 837 electronic standardelectronic standard Eases burden on hospitalsEases burden on hospitals Faster, cleaner dataFaster, cleaner data

The HIPAA designated 837 guide for The HIPAA designated 837 guide for institutional services does not include key institutional services does not include key data elements for public health reportingdata elements for public health reporting

HIGH-PRIORITY DATA ELEMENTS COLLECTED BY HIGH-PRIORITY DATA ELEMENTS COLLECTED BY STATES IDENTIFIED IN NAHDO SURVEYSTATES IDENTIFIED IN NAHDO SURVEY

(note: Yellow highlighted data elements supported by the HCSDRG (note: Yellow highlighted data elements supported by the HCSDRG & Underlined elements & Underlined elements ONLYONLY supported by the HCSDRG) supported by the HCSDRG)

PATIENT DEMOGRAPHICS PATIENT STATUS CLINICAL

LINKAGEFINANCIAL

Race and EthnicityCounty CodeMarital StatusPreferred Language SpokenOccupation and industry

E-coding (number)Pharmacy Values/HCPCSGestational. Age BirthweightAdmitting vitals

Unique patient IDPhysician IDsMothers Med Record #EMS Run #

Present on Admission FlagDNRPatient Functional Status

Source of Payment TypologyTotal provider paid amt

Data Elements Gained Using the Data Elements Gained Using the HCSRGHCSRG

Race & EthnicityRace & Ethnicity

Mother’s Medical Record NumberMother’s Medical Record Number

County of PatientCounty of Patient

Occupation and Industry CodesOccupation and Industry Codes

Preferred Language SpokenPreferred Language Spoken

Marital StatusMarital Status

Why is the Guide Needed?Why is the Guide Needed?

Provides standards-based alternative for Provides standards-based alternative for designing new state and federal data designing new state and federal data systems (i.e., NYS Emergency Department systems (i.e., NYS Emergency Department Data Collection System)Data Collection System)

Fosters standard data across statesFosters standard data across states Standard formatStandard format Standard data contentStandard data content Standard approaches to new Standard approaches to new

technology advances (i.e., XML)technology advances (i.e., XML)

X12 VersioningX12 Versioning

Level Setting with X12 TerminologyLevel Setting with X12 Terminology– 4050 – October 20024050 – October 2002– 5010 – October 20035010 – October 2003– 6020 – October 20096020 – October 2009

5010 is the version now being 5010 is the version now being implemented for HIPAA complianceimplemented for HIPAA compliance

Once again, the HCSDRG is a HIPAA Once again, the HCSDRG is a HIPAA compatiblecompatible NOT a HIPAA NOT a HIPAA compliantcompliant standardstandard

Gap Assist ToolGap Assist Tool

Web Site:Web Site:– http://www.phdsc.org/standards/x12/hcs_drgt.asp– Click on Gap Assist tool link to access the Click on Gap Assist tool link to access the

applicationapplication

OverviewOverview– A visual tool that maps the Health Care Service A visual tool that maps the Health Care Service

Data Reporting Guide to various standards, most Data Reporting Guide to various standards, most notably ANSI X12. This is done for all three notably ANSI X12. This is done for all three versions of the HCSDRG.versions of the HCSDRG.

Demo of Gap Assist ToolDemo of Gap Assist Tool

Contact InformationContact Information

Consortium Website http://www.phdsc.org

Bob Davis

rdavis@nahdo.org