Category: Uncategorized

Beginning with Q1-2025 discharge data submissions there will be changes in reporting Medicare Advantage payer classification codes. 

There is a need to analyze more granular Medicare Advantage plans that have been identified as the most utilized Medicare Advantage payers across the state. Currently, all Tennessee hospitals report all Medicare Advantage plans in patient discharge records using payer “K.” Additional Medicare Advantage payer codes, K1 – K7, have been added to the payer classification categories.  

Beginning with your Q1-2025 discharge data submissions, we ask that you make changes to the way you map your Medicare Advantage payer classification codes as described below. This change applies to primary, secondary and tertiary payer name codes (additional details about these data fields can be found in the 2020 HDDS manual on pages 65, 68 and 71). 

The Tennessee Department of Health (TDH) emailed this notice on November 22, 2024. The notice can be found here. Please report the data to THA/HIDINet using the payer classification codes listed above beginning with your Q1-2025 data submissions which are due by May 30, 2025.

THA worked with the Data Policy Committee (DPC) to review
and update the THA Data Release Policy. The main objectives of this effort were
to reflect changes in THA’s data programs by removing outdated uses, clarify
language to ensure consistent interpretation of intended uses and prohibitions,
and explore new external uses for UB discharge data in health planning and
financial disclosures. After a thorough review, the DPC recommended the updated
policy for approval to the THA Board of Directors, which approved it at its
September 2024 meeting.

Enabling these additional UB discharge data uses to support
health planning and financial disclosures requires that THA segregate member
and non-member data for data subscribers and Market Optics users. Going
forward, the non-HIN/non-member data will only be available to subscribers upon
request, and will only be added to Market Optics once the Tennessee Department
of Health (TDH) has made the data publicly available (typically 18 months after
the close of a calendar year). For example, the 2023 data will be accessible in
July 2025.

Please review the updated THA Data Release Policy which is active and replaces any previous copies you may have on file. You can find the document HERE.

As you are aware, with each new year comes a new set of CPT/HCPCS codes.  After extensive review of the new 2024 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 Q1-2024 discharge data which are due May 30, 2024. 

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 2024 THA ambulatory surgery definition: 

• 23 codes were added, and 9 codes were removed to the general surgery range of 10021-69990 
• 6 codes were added to the select included CPT code list that are not within the general surgery range
• 5 codes were added to the select HCPCS Level II code list
• 26 codes were added, and 12 codes were removed the Category III code list 

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 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 2024 CPT/HCPCS codes that are included or excluded in the ambulatory surgery definition.  

As you are aware, with each new year comes a new set of CPT/HCPCS codes.  After extensive review of the new 2023 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 Q1-2023 discharge data which are due May 30, 2023. 

Please find the updated, FINAL ambulatory surgery definition document here.  Below is a breakdown of changes for 2023 THA ambulatory surgery definition: 

• 29 codes were added, and 19 codes were removed to the general surgery range of 10021-69990  (excluding two codes as noted on page 2)
• 4 codes were added to the select included CPT code list that are not within the general surgery range
• 55 codes were added to the select HCPCS Level II code list
• 3 codes were removed, and 7 codes were added to the Category III code list 

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 2023 CPT/HCPCS codes that are included or excluded in the ambulatory surgery definition.  

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: 

• 30 CPT codes were added to the general surgery range of 10021-69990 
• 4 codes were removed, and 7 codes were added to the select included CPT code list that are not within the general surgery range
• 11 codes were removed, and 14 codes were added to the Category III selections 

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 20^th, 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 20^th, 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 23^rd, 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:

• Aesthetics improved
• Redesigned information buttons for HIDI points of contact and submission schedules added to the home page
• Modified message language created for when files are processing to avoid confusion over status of submissions
• Added variance highlights to discharge counts report with ability to select percent variance
• Added counts by month to status summary report
• Categorized and organized error corrections for ease of use –– all fields are available on correction screen
• Made record counts and status summary reports downloadable into Excel for custom reporting capabilities
• Redesigned data submission list to display hospital name in addition to facility IDs
• Last login date/time added on the authorized users splash screen
• Ability to resubmit files as replacements without deleting old files first
• Defined automated email messages for status on submissions and error rates
• Additional correction cycle to process corrections during the day instead of just once overnight.  Currently, RDDS processes from 6 p.m. to 7 pm CST.  With HIDINet v3, the second, additional cycle will run midday, from 12 p.m. to 1 p.m. CST. 

You will begin using HIDINet v3 with your Q2-2020 data submissions which are due August 29^th.  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 30^th 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 30^th. 

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 30^th!