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AGENCY FOR HEALTH CAnAREADMINISTRATIONAgency for Health Care Administration GuideAHCA Patient DataSubmission GuideIncludes All You NeedTo Comply With Data SubmissionRequirements2727 MAHAN DRIVE MS #16, TALLAHASSEE, FL 32308
Dear Friend:Our mission at the Agency for Health Care Administration is Better Health Care for allFloridians, and over the years, your data has demonstrated that health care in Florida doesindeed continue to get better, from increasing health screenings to fewer potentiallypreventable readmissions, from better care upon admission to the ER to lower costs for avariety of procedures. The data you report and that we share has been an incredibly usefultool in driving continuous improvement and in helping providers, payers and especiallypatients strive for ever-increasing quality.We value our relationships with providers across the state. You have given us meaningfulinput on both the process of collecting data and on the data standards themselves. Ourteam has listened to you, and we developed this guide to share some of those ideas andbest practices. This guide, developed by the Data Collection and Quality Assurance Unit inour Florida Center for Health Information and Transparency, was designed to help you withthe complex task of filing discharge data.We hope that this guide will be a valuable tool for you in explaining what data to file, whento file it and how to file it. It is intended to clarify the often complex regulations that havegoverned this process in the past, and we hope you will continue offering your suggestionson how we can make the process even easier in the future.In addition, if you have thoughts on how we can make this data more useful to you and thepatients and families we all serve, I hope you will let us know that, too. We are eager topartner with leaders across this state to make the data more accessible and more userfriendly, and we welcome your input.Thank you for your many years of partnering with our Agency and for joining us in our effortsto improve the quality of health care in Florida.
Table of ContentsSECTION 1 INTRODUCTION . 1Inpatient Data Collection Program . 1Ambulatory and Emergency Department Data Collection Program . 159E-7 and 59B-9 F.A.C. 2Public Release of Discharge Data . 4The Limited Data Set . 4Inpatient Data Set: . 4Ambulatory and Emergency Department Data Set: . 5Comprehensive Rehabilitation Data Set: . 5Transmission Format: . 6Available Quarters . 6Pricing . 6SECTION 2 REPORTING REQUIREMENTS . 7Reporting Periods and Due Dates . 7Penalties and Fines . 7Ambulatory Exemptions . 8Extensions. 8Resubmission Requests . 9Establishing a Facility User ID . 10Establishing/Updating a Facility Contact . 10SECTION 3 DATA SUBMISSION . 11Data File Format . 11XML Schemas . 11Data Web Site Submission Specifications . 11Data Versions . 12Data Assistance . 12Online Submission: Step-By-Step . 13File Submission Status . 18SECTION 4 HEADER RECORD . 21What Is the Declaration line . 21What Is A Header Record? . 21Transaction Code . 22Report Year . 23Report Quarter . 24Data Type . 25Submission Type . 26a
Processing Date . 27AHCA Facility Number . 28Medicare Number. 29Organization Name . 30Contact Person Name . 31Contact Person Telephone Number . 32Contact Person E-Mail Address . 33Contact Person Street or P.O. Box Address . 34Contact Person Mailing Address City . 35Contact Person Mailing Address State . 36Contact Person Mailing Address Zip Code . 37SECTION 5 INPATIENT/COMP REHAB DATA ELEMENTS. 38General Specifications . 38AHCA Facility Number . 39Patient Control Number . 40Medical or Health Record Number . 41Patient Social Security Number . 42Patient Ethnicity . 44Patient Race . 45Patient Birth Date. 46Patient Sex. 48Patient Zip Code . 49Patient Country Code . 50Type of Service Code . 51Priority of Admission . 52Source of Admission/Point of Origin . 54Admission Date . 56Inpatient Admission Time . 58Discharge Date . 59Discharge Time . 61Patient Discharge Status . 62Principal Payer Code . 64Principal Diagnosis Code. 66Other Diagnosis Code 1-30 . 68Present on Admission Indicator (POA) . 70Principal Procedure Code . 72Principal Procedure Date . 74Other Procedure Code (1-30) . 76Other Procedure Code Date (1-30) . 78b
Attending Practitioner Identification Number . 79Attending Practitioner National Provider Identification Number (NPI) . 80Operating or Performing Practitioner Identification Number . 81Operating or Performing Practitioner National Provider Identification Number . 83Other Operating or Performing Practitioner Identification Number . 84Other Operating or Performing Practitioner National Provider Identification Number (NPI) . 85Revenue Code Category Charges . 86Nursery Level I, II, III Charges . 88Total Gross Charges . 90Infant Linkage Identifier . 91Admitting Diagnosis . 93External Cause of Morbidity Code (1), External Cause of Morbidity Code (2) and External Cause of Morbidity Code (3) . 95Emergency Department (ED) Date of Arrival . 97Emergency Department (ED) Hour of Arrival . 98Condition Code . 100Trailer Record. 101SECTION 6 AMBULATORY/EMERGENCY DEPARTMENT DATA ELEMENTS . 102General Specifications . 102Criteria for Reporting Ambulatory Surgery Visits . 103Criteria for Reporting Emergency Department Visits . 104AHCA Facility Number . 105Patient Control Number . 106Medical or Health Record Number . 107Patient Social Security Number . 108Patient Ethnicity . 110Patient Race . 111Patient Birth Date. 113Patient Sex. 114Patient Zip Code . 115Patient Country Code . 116Type of Service Code . 117Source of Admission/Point of Origin . 118Principal Payer Code . 120Principal Diagnosis Code. 122Other Diagnosis Code 1-9 . 124Evaluation and Management Code (1) to (5) . 126Other CPT or HCPCS Procedure Code (1) thru (30) . 127Attending Practitioner Identification Number . 129Attending Practitioner National Provider Identification Number (NPI) . 130c
Operating or Performing Practitioner Identification Number . 131Operating or Performing Practitioner National Identification Number . 132Other Operating or Performing Practitioner Identification Number . 133Other Operating or Performing Practitioner National Identification Number . 134Revenue Code Category Charges . 135Total Gross Charges . 137Patient Visit Beginning Date . 139Patient Visit Ending Date . 141Hour of Arrival . 143Emergency Department (ED) Hour of Discharge . 145Patient’s Reason for Visit (Admitting Diagnosis) . 147External Cause of Morbidity Code (1), External Cause of Morbidity Code (2) and External Cause of Morbidity Code (3) . 148Service Location . 150Patient Discharge Status . 151Trailer Record. 153SECTION 7 REPORTS . 154Understanding the Auditing Process and AHCA Reports . 154Error Reports . 155Verification Reports (VR OR TRV) . 155Facility Error Report (FER) . 155Summary Reports . 156Audit Summary Report (AR) . 156Norm Report (NR) . 156Report Examples . 158Verification Error Report Example (VR) . 158Facility Error Report Example (FER) . 158Audit Summary Report Example (AR) . 159Reviewing Data Summary Reports. 160Data Summary Report . 160SECTION 8 APPENDICES . 162Glossary of Terms . 162Rules & Statutes . 167Forms . 167Contact Form . 167Facility User Account Agreement . 168Certification Forms . 170Florida Local Health Council Districts (Facility Regions) . 172d
Florida County Code Table . 173Practitioner License Prefix Table . 174State Abbreviations . 175Country Code List . 176Helpful Links. 181Data Specifications . 181Inpatient . 181AS/ED . 182e
SECTION 1 INTRODUCTIONInpatient Data Collection ProgramAHCA’s inpatient data collection program, as directed by Section 408.061, Florida Statutes,and Chapter 59E-7 of the Florida Administrative Code (F.A.C.), collects three types of dischargedata from 309 inpatient health care facilities: acute care hospitals, short-term psychiatricfacilities, comprehensive rehabilitation and long-term psychiatric facilities.Reportable events include discharges from acute care, intensive care, psychiatric, newbornlive discharges and deaths. Comprehensive rehabilitation data in acute care hospital isincluded in the inpatient data set.The State of Florida has collected inpatient discharge data since 1988. Beginning in 1997,short-term acute care psychiatric hospitals were included as well. Long-term psychiatrichospitals were added in 2006. The 52 data elements that comprise the inpatient data areused by universities, the hospital industry, and government to evaluate the state’s health caresystem.Comprehensive rehabilitation discharge data collection started in since 1993. The data isdetail patient level but based on the HCFA10 primary condition codes. This data set wascollected in accordance with Section 408.61, Florida Statutes, and by Chapter 59E-7.201,F.A.C., until January 1, 2010.Ambulatory and Emergency Department Data Collection ProgramAHCA’s ambulatory (AS) patient data collection program began in 1997 with thecommencement of the collection of discharge data from the state’s freestanding ambulatorysurgical centers, radiation therapy centers (ended 12/31/02), lithotripsy centers, cardiaccatheterization laboratories, and short-term acute care hospitals.Emergency Department (ED) Discharge Data has been collected since 2005. Data includesall emergency department visits during which ED registration occurs, but the patient is notadmitted for inpatient care at the reporting entity. Data is submitted in accordance withSection 408.061, Florida Statutes, and Chapter 59B-9, F.A.C. Ambulatory data is authorizedunder the direction of Section 408.061, Florida Statutes, and Chapter 59B-9, F.A.C.Historically, data was collected from approximately 650 freestanding ambulatory surgicalcenters and about 300 short-term acute care hospita
An Agency for Health Care Administration Guide AGENCY FOR HEALTH CARE ADMINISTRATION AHCA Patient Data Submission Guide 2 7 2 7 M A H A N D R I V E MS # 1 6 , T A L L A H A S S E E, F L 3 2 3 0 8 Includes All You Need To Comply With Data Submission
