Current through Reg. 49, No. 38; September 20, 2024
(a) To verify the accuracy of all discharge
claims prior to public release, DSHS shall establish procedures for the review
of all discharge reports to determine whether the report is acceptable, as
required by Health and Safety Code, §
108.011.
(b) Upon receipt of a discharge report, DSHS
shall determine if it satisfies minimum criteria for processing. If it does
not, DSHS shall return the discharge report in the same submission format and
media that is approved for that provider and state the deficiencies in writing
within ten calendar days of receipt. The hospital shall resubmit the report
within ten calendar days of notification by DSHS. A discharge report does not
meet minimum standards for processing under the following circumstances as
shown in paragraphs (1) - (3) of this subsection.
(1) The physical media and labeling do not
conform to the specifications in §
421.4
of this title (relating to Instructions for Filing Discharge
Reports).
(2) The physical media
are unreadable due to physical damage.
(3) The file structure does not conform to
the specifications in §
421.9
of this title (relating to Discharge Reports--Records, Data Fields and Codes),
unless the hospital has received a letter from DSHS authorizing filing in
another format.
(c)
Correction of Errors.
(1) DSHS shall review
all discharge reports accepted for processing and will process all discharge
claims against the editing criteria established by this section and by DSHS.
Within 10 calendar days of receipt of an accepted discharge report, DSHS shall
notify the hospital in detail of all errors detected in the discharge
report.
(2) Within 30 calendar days
of receiving initial notice of errors in a discharge report, the hospital shall
correct all discharge claims containing errors, add any discharge claims
determined to be missing from the initial discharge report and resubmit the
corrected and/or previously missing discharge claims. If the hospital disagrees
with any identified error, the hospital may indicate that the discharge claim
is as accurate as it can be or cannot be corrected. Each hospital shall submit
such modified and/or additional discharge claims as may be required to allow
the chief executive officer or the chief executive officer's designated agent
to certify the quarterly discharge report as required by §
421.7
of this title (relating to Certification of Discharge Reports). Corrections to
a discharge report shall be submitted on approved media and formats as
specified in §
421.4
of this title and §
421.9
of this title unless DSHS approves another medium or format.
(3) Within ten calendar days of receiving
corrections to a discharge report from a hospital, DSHS shall notify the
hospital of any remaining errors. The hospital shall have ten calendar days
from receipt of this notice to correct the errors noted or indicate why the
data should be deemed acceptable and complete. This process may be repeated
until the data is substantially accurate and the hospital is able to certify
the discharge report as required by §
421.7
of this title or the deadline for submitting corrections prior to certification
is reached. Corrected data is required to be submitted on or before the
following dates for the respective quarter's discharges; Quarter 1 - August 1,
Quarter 2 - November 1, Quarter 3 - February 1, Quarter 4 - May 1. No
individual hospitals will be granted extensions to the dates. DSHS may grant an
extension to all hospitals when deemed necessary.
(4) Discharge claims that have not been
previously submitted shall be submitted prior to the deadline for the following
quarter's data. Correction and certification of these previously missing or
additional discharge claims for the prior calendar quarter shall be made
according to the deadlines established for following quarter in which the data
that is scheduled to be processed as specified in §
421.3(a)(1)
of this title (relating to the Schedule for Filing Discharge Reports),
paragraph (3) of this subsection (relating to the Acceptance of Discharge
Reports and Correction of Errors) and §
421.7(b) and
(d) of this title. Corrections to discharge
claims previously submitted or that have a discharge date prior to calendar
quarter immediately before the calendar quarter being processed scheduled will
not be processed.
(d)
DSHS will document and DSHS will approve all acceptance and editing criteria
utilized in reviewing discharge reports. If acceptance and editing criteria are
incorporated into computer software, and if the software is the property of
DSHS, DSHS will make copies of the portions of the software containing the
criteria available on paper, magnetic, or other portable data storage media.
DSHS shall make this information available to submitters without charge and to
others for the cost of reproduction.
(e) Failure to correct or comment on a
discharge report which has been filed but contains errors or omissions, known
to the hospital, within the due dates in §
421.3
of this title is punishable by a civil penalty pursuant to Health and Safety
Code, §
108.014.
