Illinois Administrative Code
Title 77 - PUBLIC HEALTH
Part 1010 - HEALTH CARE DATA COLLECTION AND SUBMISSION CODE
Section 1010.40 - Data Submission Requirements
Universal Citation: 77 IL Admin Code ยง 1010.40
Current through Register Vol. 48, No. 12, March 22, 2024
a) Inpatient and Outpatient Claims and Encounter Data
1) Hospitals and ambulatory
surgical treatment centers shall electronically submit patient claims and
encounter data, as outlined in this subsection (a), to the Department no later
than the initial closing date, 60 calendar days after the last day of each
calendar quarter. Calendar quarters shall begin on January 1, April 1, July 1,
and October 1 and shall end on March 31, June 30, September 30, and December
31. Beginning no later than 45 days after the last day of each calendar
quarter, hospitals and ambulatory surgical treatment centers shall begin an
internal review of all quarterly data accepted by the Department. The quarterly
review shall involve detailed evaluation of data quality feedback reports by
facility staff with sufficient general knowledge of patient mix and services
provided to allow identification of unreasonable or incomplete submission
statistics.
A) Hospitals shall submit to the
Department:
i) Claims and encounter data
pertaining to each inpatient discharged. Production and test data shall be
submitted as specified in Appendix A;
ii) Claims and encounter data pertaining to
case data for each emergency department (ED) visit (wherever care is
administered) and each observation case (OC) in the outpatient format specified
in Appendix C; and
iii) Claims and
encounter data related to diagnostic or therapeutic imaging conducted during or
related to an inpatient stay that may include, but are not limited to,
techniques described in Appendix K. These data may include, but are not limited
to, events occurring during a visit for surgery or scheduled imaging for
purposes of evaluating the need for treatment, determining the nature or extent
of necessary treatment, or evaluating the outcomes of treatment. Data elements
for these cases, specified in Appendix C, shall begin with the cases for
patients discharged on October 1, 2012.
B) Hospitals and ambulatory surgical
treatment centers shall report to the Department:
i) Information relating to any patient
treated with an ambulatory surgical procedure within any of the general types
of surgeries as specified in Appendix B;
ii) Claims and encounter data for each
surgical or invasive procedure outlined in subsection (a)(1)(B)(i), as
specified in Appendix C;
iii)
Claims and encounter data related to diagnostic or therapeutic imaging that may
include, but are not limited to, techniques described in Appendix K. These data
may include, but are not limited to, events occurring during a visit for
surgery or scheduled imaging for purposes of evaluating the need for treatment,
determining the nature or extent of necessary treatment, or evaluating the
outcomes of treatment. Data elements for these cases, specified in Appendix C,
shall begin with the cases for patients discharged on October 1,
2012.
C) Only data
consisting of the elements listed in Appendices A and C in the expanded format,
as detailed in the Department's data submission manual, will be
accepted.
2) Each
hospital and ambulatory surgical treatment center shall electronically submit
to the Department all patient claims and encounter data pursuant to this
subsection (a). These submissions shall be in accordance with the uniform
electronic transaction standards and code set standards adopted by the
Secretary of Health and Human Services under the Social Security Act and the
physical specifications, format and record layout specified in the Department's
data submission manual.
3) To be
considered compliant with this Section, a hospital's or ambulatory surgical
treatment center's data submission shall:
A)
Be submitted to the Department electronically, as specified in the data
submission manual;
B) Consist of an
individual facility data file; and
C) Meet the Department's minimum level of
data submission compliance on or before the data submission due date. Hospitals
and ambulatory surgical treatment centers shall maintain a compliance
percentage of no less than 98% for each calendar month.
4) Failure to comply with this Section may
subject the facility to penalties as provided in the Ambulatory Surgical
Treatment Center Act and the Hospital Licensing Act.
b) Inpatient and Outpatient Report of Monthly Discharge and Outpatient Surgery Counts
1)
Each hospital shall, within 30 calendar days following the last day of each
calendar month, submit:
A) The actual total
number of hospital inpatient discharges for that calendar month. In the case of
multiple births, each child is counted as a discharge. This number shall
include those inpatient cases receiving diagnostic or therapeutic imaging as
defined in subsection (a)(1)(A)(iii); and
B) The actual number of hospital outpatient
cases with a surgical procedure as defined in this Part for that calendar
month.
2) Each hospital
shall, within 30 calendar days following the last day of each calendar month,
submit for each category the actual number of hospital outpatient cases with an
emergency department visit, observation stay, or surgery, as defined in this
Part for that calendar month. Beginning with patients discharged on October 1,
2012, each hospital shall submit the actual number of cases with an outpatient
visit for diagnostic or therapeutic imaging as defined in subsection
(a)(1)(B)(iii). Each patient shall be counted only once, except that
imaging-only visits shall be counted separately. Outpatient surgical cases,
regardless of other services, shall be counted as surgical cases. Non-surgical
cases, excluding imaging-only visits, shall be counted separately as ED or OC,
based on the last service received.
3) Each ambulatory surgical treatment center
shall, within 30 calendar days following the last day of each calendar month,
submit the actual total number of licensed ambulatory surgical treatment center
outpatient cases with surgery for that calendar month as defined in this Part.
Beginning with patients discharged on October 1, 2012, this count shall include
the actual number of cases with a visit for diagnostic or therapeutic imaging
as defined in subsection (a)(1)(B)(iii).
4) All filings required in this Section shall
be reported using the Department's electronic submission systems.
5) Effective 60 days after the end of each
calendar quarter, monthly reported discharge count acceptance for that calendar
quarter will end. If any facility finds it necessary to change monthly reported
counts after the initial closing date and before the final closing date, the
facility administrator shall submit the revised monthly count with a written
justification.
c) Syndromic Surveillance
Hospitals are facilities that are mandated to report and urgent care centers and other facilities providing urgent care services are recommended to report the following:
1)
Facilities shall electronically submit all patient clinical encounter data, as
outlined in this subsection (c), to the Department in near real-time, no later
than 24 hours from the initial patient date and time of visit, and preferably
within 1 hour of the encounter. Updates to the patient record shall also be
submitted within these timeframes. Facilities shall submit to the Department:
A) Clinical encounter data pertaining to each
Emergency Department (ED) visit. Message types for Registration, Admissions,
Discharge and Update to be submitted. Production data elements are specified in
Appendix L;
B) Clinical encounter
data pertaining to all inpatient visits. Message types for Admission, Updates
and Discharge to be submitted. Production data elements are specified in
Appendix L;
C) Clinical encounter
data pertaining to observation visits which may occur as a result of an ED
visits or precede an inpatient admission. Production data elements are
specified in Appendix L; and
D)
Clinical encounter data pertaining to urgent care visits as defined in Section
1010.20.
2) Each facility shall electronically submit
to the Department all patient clinical encounter data pursuant to this
subsection (c). These submissions shall be in accordance with the uniform
electronic transaction standards and code set standards adopted by the Office
of the National Coordinator and the CMMS in accordance with the HITECH Act of
2009 and the HL7 specifications, format and record layout specified in the HL7
syndromic surveillance implementation guide version
2.0 or later as adopted by the
HL7 organization.
3) To be
considered compliant with this Section, a facility's data submission shall:
A) Be submitted to the Department
electronically, in near real-time no later than within 24 hours of the date and
time of visit.
B) Consist of
batched HL7 version 2.5.1 messages.
C) Meet the Department's minimum level of
data submission compliance for data quality standards for completion of
elements outlined in Appendix L.
D)
Be submitted for every calendar day. Any outages of data submission will need
to be backfilled once issues are resolved.
E) Facilities shall provide notice one week
in advance of the reporting system being offline for 24 hours or more for any
reason such as system upgrade or vendor transition, if the event was planned.
In the event of an unplanned system outage, hospitals shall make all possible
attempts to bring the system online in a timely manner.
F) Any facility that falls out of compliance
for more than seven days shall submit a resolution plan to the Department with
a correction timeline of 30 days.
G) Facilities may submit data directly to the
Department or through a third party acting as their agent. Providers selecting
this option are responsible for ensuring that all data specifications conform
to the requirements of this Part.
4) Failure to comply with this Section may
subject the facility to penalties as provided in the Ambulatory Surgical
Treatment Center Act and the Hospital Licensing Act.
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