The quarterly user group webinars serve as a resource to HIN member data policy and technical contacts, as well as other HIDINet users, to better understand the data submission and quality review processes for the quarterly discharge data submissions.
The resources for the Q1-2022 webinar are linked below.
As you are aware, with each new year comes a new set of CPT/HCPCS codes. After extensive review of the new 2022 codes by the Tennessee Hospital Association (THA) and the Tennessee Health Information Management Association (THIMA) professionals, we have determined which codes should be included or excluded from the ambulatory surgery definition beginning with the Q1-2022 discharge data which are due May 30, 2022.
Please find the updated, change version, definition document here. As you review the document you will see changes to the special inclusion and exclusion lists: codes removed are highlighted in yellow; and codes added are highlighted in peach. You may also find the FINAL ambulatory surgery definition document here (this version does not include markups). Below is a breakdown of changes for 2022 THA ambulatory surgery definition:
This update will continue to be made each year with the release of new CPT/HCPCS codes.
The THA ambulatory surgery definition document is made available so you understand how HIDINet flags your outpatient records as an ambulatory surgery record. Please continue to submit all of your outpatient records as you currently do, and the system will continue to define and flag the ambulatory surgery records for you.
You do not have to make any changes to the way you currently submit your data. This is only an update to reflect the new 2022 CPT/HCPCS codes that are included or excluded in the ambulatory surgery definition.
As part of the Families First Coronavirus Response Act, the Paycheck Protection Program and Health Care Enhancement Act, and the Coronavirus Aid, Relief, and Economic Security (CARES) Act , the U.S. Department of Health and Human Services (HHS) will provide claims reimbursement to health care providers generally at Medicare rates for testing uninsured individuals for COVID-19 and treating uninsured individuals with a COVID-19 diagnosis.
The Tennessee Department of Health emailed a letter on September 17, 2020, with instructions on payer mapping and payer ID/health plan ID for these types of claims. The letter can be found here. Please report the data to THA/HIDINet using the following payer code and payer ID/health plan ID for the uninsured patients
Field Description/Field #: Payer Name Code – Primary / # 165
Position: 1440-1443
Payer Code: Z
Field Description/Field #: Payer ID/Health Plan ID – Primary / # 168
Position: 1452-1466
Payer ID/Health Plan ID: 95964
The National Uniform Billing Committee (NUBC) recently approved a new Point of Origin (PoO) code, G, “Transfer from a Designated Disaster Alternative Care Site (ACS).” This additional PoO code was added relative to the COVID-19 Public Health Emergency (PHE). It became effective for discharges on or after July 1, 2020.
The PoO data element can be found in Form Locator 15 of the UB-04 form. It is then reported to THA’s HIDINet platform for state reporting in Field 18, Position 176-177 of your data file. The detail of this change can be found in the NUBC minutes, as referenced in the UB-04 Change Implementation Calendar.
For further reference, here is a direct link to CMS’ MLN publication regarding this change: https://www.cms.gov/files/document/mm11836.pdf
Make sure your billing staffs are aware of this change.
Please remember the importance of reviewing all data elements, including PoO counts, in your hospital(s) verification report after each quarterly data submission to THA’s HIDINet v3. The new PoO code, G, has been added to this report.
We are pleased to announce that our data partner, the Hospital Industry Data Institute (HIDI), has released a new, upgraded version of their data submission and collection platform called HIDINet v3.
Beginning Monday, July 20th, all users will be transitioned to the new platform, HIDInet v3. The new platform has a different URL from the current site and new log in credentials will be provided to each current user. During the week of July 20th, you will receive an email notification from HIDI staff containing your credentials to activate your account and access the new site. It is very important that you follow the email instructions and complete your transition to the new site as quickly as possible. If you have not received email notification from HIDI by July 23rd, please contact us through the link at the bottom of this notification.
HIDI has created a recorded training session that you can watch at any time to become familiar with the new HIDINet v3 site. You can access the recording once you have received your new login credentials and have logged in to the new platform. The recorded training session, HIDINet Demo, will be available under the Documentation tab on the HIDINet v3 site. We encourage you to read the website documentation, THA HIDINet v3 Website Information _06-25-2020, also found under the Documentation tab on the new platform.
HIDINet v3 is very much like the current RDDS and we believe the transition from RDDS to HIDINet v3 will be seamless. The upload specifications and data threshold rules have not changed, however, there have been several site enhancements made by HIDI. Below is a preview of the list of enhancements that have been built into the new platform.
HIDINet v3 Enhancements:
You will begin using HIDINet v3 with your Q2-2020 data submissions which are due August 29th. Please utilize this time to become familiar with HIDINet v3. Please note, if you have already submitted your Q2-2020 data, you do NOT have to resubmit. All data will be moved to the new platform.
On Thursday, April 16, 2020, you received an email from the Tennessee Department of Health (TDH) regarding early reporting of your Q1-2020 data. You can access the full letter here.
The TDH specifically asks if you have the Q1-2020 data ready for submission and can submit it early, please do so. The original submission due date for Q1-2020 data is May 30th and you will not be penalized if you choose to wait until that date. However, by reporting early, they hope to relieve this task from potential issues that may be occurring within your facility/system at the time of the original due date on May 30th.
THA supports the request from the TDH on early reporting for Q1-2020, if you can.
Today, April 1, 2020, the Tennessee Department of Health (TDH) emailed all licensed Tennessee Hospitals a letter requesting information on your yearly UB-04 discharge data submissions. A copy of the letter can be found here. The TDH will continue to send this request annually. They are asking each hospital to submit the PH-3925 Reporting Method form, found here, before April 30. The TDH asks that you send your form back via email to Healthcare.Statistics@tn.gov, please do not fax.
When filling out the Annual Reporting Method form, THA member hospitals should select “THA” under section II, Annual Submissions. Also, under section II, select all four quarters and input 2020 for the year. Complete sections I and III in its entirety.
Thank you for completing this annual task by April 30th!
As you are aware, with each new year comes a new set of CPT/HCPCS codes. After extensive review of the new 2020 codes by the Tennessee Hospital Association (THA) and the Tennessee Health Information Management Association (THIMA) professionals, we have determined which codes should be included or excluded from the ambulatory surgery definition beginning with the Q1-2020 discharge data which are due May 30, 2020.
Please find the updated, change version, definition document here. As you review the document you will see changes to the special inclusion and exclusion lists: codes being removed are highlighted in yellow; and codes being added are highlighted in peach. You may also find the FINAL ambulatory surgery definition document here (this version does not include markups). Below is a breakdown of changes for 2020 THA ambulatory surgery definition:
This update will continue to be made each year with the release of new CPT/HCPCS codes.
The THA ambulatory surgery definition document is made available so you understand how the Remote Discharge Data System (RDDS) flags your outpatient records as an ambulatory surgery record. Please continue to submit all of your outpatient records as you currently do and the system will continue to define and flag the ambulatory surgery records for you.
You do not have to make any changes to the way you currently submit your data. This is only an update to reflect the new 2020 CPT/HCPCS codes that are included or excluded in the ambulatory surgery definition.
NOTE: If you have submitted your Q1-2020 data prior to this date, March 27, 2020, you will receive a new verification and edit summary report in your email box over the coming days for your review.
Last October you received the message below following a letter from the TN Department of Health (TDH) requesting a change on the Health Plan ID fields – specifically the primary field, field #168. The TDH wanted to see better data in this field and asked that the field be edited with a fatal error beginning with the Q1-2020 data submissions. THA placed a warning edit on the health plan ID fields for the submission of your Q3 and Q4-19 data. You can read the details in my previous email listed below.
Since then we learned that the Federal Registry rescinded the requirement for health plans to maintain their health plan identification numbers effective December 2019. We had a conversation with the TDH and the state agreed to leave the warning edit on the Primary Health Plan ID (field 168) at this time. The warning edit, # 6204, will not turn into a fatal edit beginning with the Q1-2020 data submissions. We will have further conversation with the state over the coming weeks regarding the health plan ID field edits and will communicate the final outcome.
PREVIOUS MESSAGE:
On Friday, October 11, 2019, the Tennessee Department of Health (TDH) emailed all licensed Tennessee hospitals a letter requesting improvement of data in all health plan identification fields (primary, secondary and tertiary). Please find that letter HERE. The specific field numbers in reference are 168-170 in your RDDS UB04 record layout; or reference UB-04 form locators 51A-51C. The letter stated that many hospitals are reporting all 9s in these fields which is not acceptable. The TDH is asking all hospitals to begin submitting more viable data for these fields, specifically the PRIMARY health plan ID field, on or before the Q1-2020 discharge data submission which is due to the Remote Discharge Data System (RDDS) no later than May 30, 2020. The TDH further indicated if the health plan identification field – PRIMARY ONLY – does not contain valid identifiers beginning with the Q1-2020 data submission, this field (field # 168) will be edited and considered a fatal error. This could potentially push your facility above the 2% fatal error threshold which will not allow your data to be submitted to the TDH and making you susceptible to penalties as described in the rules of the state law.
Please note: The secondary and tertiary health plan identification fields will remain warning errors beginning with Q1-2020 data submissions. However, you should continue to monitor these fields as well.
In order to prepare for the change set by the TDH, The Tennessee Hospital Association (THA) analyzed the 2018 final data and found the TDH facts to be true, many hospitals are submitting all 9s in the indicated primary health plan identification field. In order to meet the requests of the TDH, THA will redesign the existing warning edits by changing the logic and further making the PRIMARY health plan ID field FATAL beginning with your Q1-2020 data submission. The warning edits that have been set in place for the health plan identification fields (RDDS UB04 record layout field numbers 168-170 or UB FLs 51A-51C) are listed below. These are the warnings you should look for and evaluate in your Q3 and Q4-19 data submissions, particularly edit # 6204.
| Edit No. New for Q3&Q4-19 | Edit Type | Edit Description | Layout Field No. | Layout Field Description | Layout Positions |
| 6204 | Warning | Primary health plan number is missing or invalid | 168 | Payer ID/Health Plan ID – Primary (pg 74 HDDS Manual) | 1452-1466 |
| 6205 | Warning | Secondary health plan number is missing or invalid | 169 | Payer ID/Health Plan ID – Secondary (pg 75 HDDS Manual) | 1467-1481 |
| 6206 | Warning | Tertiary health plan number is missing or invalid | 173 | Payer ID/Health Plan ID – Tertiary (pg 76 HDDS Manual) | 1482-1496 |
In order to prepare for the change set by the TDH, the following fatal edit will be active for the PRIMARY health plan ID field beginning with your Q1-2020 discharge data submission to RDDS due May 30, 2020:
| Edit No. New for Q1-20 | Edit Type | Edit Description | Edit Logic | Layout Field No. | Layout Field Description | Layout Positions |
| 6207 | FATAL | Primary health plan number is missing or invalid | Fatal error when the field contains blanks and the primary payer is not equal to 0, P, Z or blank; or the field contains a string of 9s or zeros. | 168 | Payer ID/Health Plan ID – Primary (pg 74 HDDS Manual) | 1452-1466 |
*Please note, the layout field descriptions and positions can be found in the HDDS manual. If you do not have a copy of the manual, you can find it by logging into RDDS or on our website, THA-HIN.com, by clicking HERE.How can you be prepared?
As you submit your Q3-19 (due November 29, 2019) and Q4-19 (due March 1, 2020) discharge data to RDDS, please carefully review your edit summary and edit detail reports in RDDS and look for the existing warning edits, 6204-6206, with special attention to the PRIMARY health plan ID field (edit 6204). This will help you determine if your data needs attention in these particular fields prior to the Q1-2020 data being submitted by May 30, 2020. If you have a >2% of the 6204 warning applied in your reports as you submit your Q3 and Q4-19 data, keep in mind these will turn to fatal errors beginning with your Q1-2020 data submission, in turn, placing your fatal error rate above the 2% threshold allowed by the TDH.
THA staff will reach out to your hospital(s) over the coming weeks if we found major issues with these fields while analyzing the 2018 data. We want to better prepare you for 2020 data submissions.
MedPAC’s June 2017 Report to Congress states that there has been significant growth recently in the number of health care facilities located apart from hospitals that are devoted primarily to emergency department services; including both OPPS-eligible off-campus provider-based emergency departments and OPPS-ineligible freestanding emergency departments not affiliated with a hospital.
In order to track this, CMS is, through subregulatory process, requiring that effective January 1, 2019, a HCPCS modifier “ER” (items and services furnished by a provider-based off-campus emergency department) be reported with every claim line for outpatient hospital services furnished in an off-campus provider-based emergency department. The modifier would be reported in the UB-04 form for hospital outpatient services.
Summary:
Please make the necessary changes to comply with this requirement effective January 1, 2019. THA will analyze the data throughout 2019 and assess the usage of this new modifier, ER, for freestanding EDs. NOTE: As a THA-HIN member, you must continue to report your freestanding ED data to us, at this time, using bill type 078X.
