building blocks for health data standards health care service: data reporting guide by bob davis...
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Building Blocks for Health Building Blocks for Health Data StandardsData Standards
Health Care Service: Data Reporting GuideHealth Care Service: Data Reporting GuideByBy
Bob DavisBob DavisMarch 18, 2004March 18, 2004
Heath Care Service: Data Heath Care Service: Data Reporting GuideReporting Guide
• Objective: Maintain a standardized format and data content for reporting health care service data that is compatible with the 837 Health Claim transaction set standards identified by the Health Insurance Portability and Accountability Act (HIPAA)
• Accomplishments: Published first version of guide in 2003
Standards Level SettingStandards Level Setting• 4010 Version
– View of ANSI ASC X12 standard as of October 1997
– HIPAA Version• 4050 Version
– View of ANSI ASC X12 standard as of October 2001
– Current Health Care Service: Data Reporting Guide
Standards Level SettingStandards Level Setting
• 5010 Version– View of ANSI ASC
X12 standard as of October 2003
– Health Care Service: Data Reporting Guide in development
– Synchronizing with Health Care Claim Guides
On the Development Dock for On the Development Dock for Health Care Service: Data Reporting GuideHealth Care Service: Data Reporting Guide
• Highlights of Planned 5010 Changes– Support being added for ICD-10-CM Diagnosis Codes– Support being added for ICD-10-PCS Procedure
codes– Additional “slots” for reporting external cause of injury
codes being included. – A separate “slot” for reporting admitting diagnosis and
the Patient’s Reason for Visit being included.
NOTE: All the above changes also being included in the health care claim guides
On the Development Dock for On the Development Dock for Health Care Service: Data Reporting GuideHealth Care Service: Data Reporting Guide
• Highlights of Change (cont)– Support being added for National Provider
Identifier– Refining situational notes in accordance
with ANSI ASC X12N TG4 implementation guide guidelines• If not required, do not send• If not required, may be provided at the
sender’s discretion
On the Development Dock for On the Development Dock for Health Care Service: Data Reporting GuideHealth Care Service: Data Reporting Guide
• Highlights of Change (cont)– Synchronizing of the Health Care Service:
Data Reporting Guide with the Health Care Claim guides where appropriate.
– Working with NUBC to better clarify ambiguous definitions (i.e. inpatient & outpatient)
Unanswered QuestionsUnanswered Questions
• Should the next release of the HCSDRG include support for professional services?
• Should the next release of the HCSDRG include support for more clinical data?
• Should the next release of the HCSDRG include support for the diagnosis indicator for external cause of injury codes?
SummarySummary
• 5010 Version of Health Care Service: Data Reporting Guide in progress & help appreciated.
• Draft for review and comment expected by end of July 2004.
• Constantly seeking input and comment on clarity and content of the Health Care Service: Data Reporting Guide.
Health Care Service: Data Reporting Guide Health Care Service: Data Reporting Guide Work Group MembersWork Group Members
• Roxanne Andrews, Senior Service Fellow Agency for Healthcare Research and Quality (AHRQ)
• Ginger Cox, Research Analyst IICalifornia Office of Statewide Health Planning and Development (OSHPD)
• Jason Goldwater, Health Insurance Specialist Centers for Medicare and Medicaid Services (CMS)
• Marjorie Greenberg, Chief,Classifications and Public Health Data StandardsCenters for Disease Control and Prevention (CDC)National Center for Health Statistics (NCHS)
• Vicki Hohner, Senior ConsultantFox Systems, Inc.
• Alana Knudson-Buresh, Senior Health Informatics Specialist National Association of Health Data Organizations
• Denise Love, Executive DirectorNational Association of Health Data Organizations (NAHDO)
• Jane McGinnis, Managed Care EpidemiologistNebraska Health and Human Services System
• Kathleen Nardini, Research AnalystNational Association of State Alcohol and Drug Abuse Directors (NASADAD)
• Judy Parlato, Clinical AdvisorMassachusetts Division of Health Care Finance and Policy
• Dan Pollock, Medical EpidemiologistCenters for Disease Control and Prevention
• Russ Scarato, EconomistHealth Resources and Services Administration (HRSA)
• Claudia Steiner, Senior Research PhysicianAgency for Healthcare Research and Quality (AHRQ)
• Charles Wentzel, StatisticianPennsylvania Health Care Cost Containment Council
• Michelle Williamson, Health Informatics SpecialistCenters for Disease Control and Prevention CDC)National Center for Health Statistics (NCHS)
• Your Name Awaits
