Outpatient Data Reporting Requirements
Texas Health Care Information Collection
Center for Health Statistics
Frequently Asked Questions
- What data is required to be reported?
THCIC is required to collect administrative data on patients that receive outpatient surgical or radiological services at hospitals or Ambulatory Surgery Centers (ASCs). The data required to be reported is the same as what is sent to a payer (Medicare, Medicaid, insurance), but the data sent to THCIC must also include information on the patient's race and ethnicity and the facility's THCIC ID number, also self-pay patients and charitable patients must be submitted.
How do we get a THCIC ID number?
A THCIC ID number is generated when a hospital or ASC is issued a license by DSHS Health Facility Licensing. The hospital or ASC is notified and given the THCIC ID number. The Hospital/Ambulatory Surgery Centers (ASC) List (Excel format, 461K) is available on the THCIC website and is updated quarterly. It includes names and addresses, county, CEO, primary and alternate THCIC liaisons, reporting status, and facility type.
- What is a submitter how and do we get one?
A Submitter ID is needed when submitting an electronic file of data. It is not the same as the THCIC ID number. If the ASC submits an electronic file it will need a Submitter ID, if the ASC's vendor submits the file the vendor will need the Submitter ID. Enrollment for a Submitter ID is posted at Submitter ID Enrollment. All new submitters must be approved by System13 to submit electronic files
- When are the deadlines for reporting data?
The schedule for reporting, correcting, and certifying data is available on the THCIC website. The schedule is set by administrative rule and the dates change only if they fall on a Saturday or Sunday when the data is due the next business day. The data may be submitted, corrected and certified before the deadlines listed in the schedule. The data collection system will allow the facility to complete the processes much more quickly than the schedule requires.
- In what format must the outpatient data be submitted?
Data must be submitted to System13 in a THCIC 837 (modified ANSI X12N 837, version 5010 Institutional Claim (837 I) (this is the preferred format) or modified ANSI X12N 837, version 5010 Professional Claim (837 P)) format. These are the same formats in which data is submitted to third-party payers, with the additional requirement for the submission of race, ethnicity and the facility’s THCIC ID number. Information on the file formats can be found in the THCIC 837 Technical Specifications (PDF, 345 MB) on the THCIC website.
- How is the data collected by the hospital or ASC put into the required format?
Data is usually collected by hospitals and ASCs in a proprietary software print image format of a paper UB04 or CMS 1500 forms. The print images of these forms are sent to the vendor that translates these files to 837 I or 837 P formats, depending on the requirements of the payers. The clearinghouses then send these files to the payers (Medicare, Medicaid, Insurance). Hospitals and ASCs may use the same clearinghouses or vendors to also send the 837 files, with the addition of race, ethnicity and the THCIC ID number, to THCIC’s Data Collection vendor, System13, Inc.
- When can data be submitted?
Test files may be submitted once a Submitter ID has been requested and issued. Test files will be reviewed by System13, Inc. and the submitter will be notified of the results in one business day. Submitters must submit test files and receive approval in order to have production data processed.
- What are the different processes?
The data collection system will allow the facility to complete the processes much more quickly than what is required in the schedule.
- There are three required processes. The deadlines for completing these steps are listed in the data reporting schedule.
- Data Submission All data will be submitted via the web through a secure website. Data can be submitted in two ways:
- The data can be manually entered using a THCIC provided system called WebClaim. WebClaim is a manual data entry tool where all claims must be entered one claim at a time.
- Claims data files can be submitted to System13 in the THCIC 837 (modified ANSI X12N 837, version 5010 Institutional Claim or modified ANSI X12N 837, version 5010 Professional Claim) format. Files can be submitted after the submitter has successfully submitted a test file and has been approved for submitting production data.
- Inpatient data should not be submitted with outpatient data.
- Data Correction After the data has been submitted as production data it is audited and checked for errors. The facility is notified by email of any errors within 24 hours of the file submission. The errors can be corrected using an online tool called WebCorrect. Errors can also be corrected through the submission of replacement claims to the THCIC secure website.
- Data Certification After the quarterly data has been submitted and corrected the facility is required to certify the data as being complete and accurate.
- What is the required data?
The required data elements for the 837 Institutional format are listed in the Technical Specification Manual for Outpatient Facilities, section 220.127.116.11, beginning on page 14. The required data elements for the 837 Professional format are listed in section 18.104.22.168, beginning on page 16. The required data includes administrative data required for submission to payers (Medicare, Medicaid, Insurance) and three additional data elements, Race, Ethnicity and the THCIC ID number.
- How is race and ethnicity collected?
Texas law requires THCIC to collect information on the race and ethnicity of patients. Health care facilities are required to ask patients to identify their own race and ethnic backgrounds. If patients fail to identify their own race and ethnic backgrounds, hospital staff will use its best judgment in making the identification. The information needed is as follows:
Additional information on the collection of patient race and ethnicity may be found in the 5010 Appendices document.
- Ethnic Background (The patient should be asked which most accurately identifies his/her ethnic background.)
Is the patient . . .?
- Not Hispanic/Latino
- Race (The patient should be asked which most accurately identifies his or her race.)
Is the patient . . .?
- American Indian/Eskimo/Aleut
- Asian or Pacific Islander
- Other (Includes all other responses not listed above. Patients who consider themselves as multiracial or mixed race should choose this category.)
- What happens if we don’t submit the data?
Within a week of the submission due date an e-mail is sent to the primary contact for the facility stating that THCIC did not receive the required data. A follow up e-mail may be sent if the data hasn’t been received with 14 days of the submission due date. A facility incurs a penalty if it does not send the required data within 28 days of each quarterly due date. Penalties are currently $1000 for the first offense (first penalty letter), $2000 for the second offense, $4000 for the third offense, and $8000 for the fourth offense. Offenses incurred after the fourth penalty letter are referred to DSHS Office of General Counsel and then to the Office of the Attorney General for court action and more penalties.
- Which ASC’s are exempt from submitting data?
A health care provider may qualify for an exemption from reporting data to THCIC if the facility meets one of the two following criteria:
- Rural Provider
- located in a county that:
- has a population estimated by the U. S. Bureau of the Census to be not more than 35,000 as of July 1 of the most recent year for which county population estimates have been published; or
- has a population of more than 35,000, but does not have more than 100 licensed hospital beds and is not located in an area that is delineated as an urbanized area by the U. S. Bureau of the Census; and
- is not a state-owned health care facility or a healthcare facility that is managed or directly or indirectly owned by an individual, association, partnership, corporation, or other legal entity that owns or manages one or more other health care facilities. (Sec. 108.0025, Texas Health and Safety Code)
- Exempt from state franchise, sales, ad valorem, or other state or local taxes; and does not seek or receive reimbursement for providing health care services to patients from any source, including:
- the patient or any person legally obligated to support the patient,
- a third-party payor, or
- Medicaid, Medicare, or any other federal, state, or local program for indigent health care.
- Who pays the cost for this State mandated requirement?
In order to be in compliance with the state mandated requirement, the cost is the responsibility of the health care facility required to submit the data.
- How and when will training be provided?
On-line training is offered on a regularly scheduled basis. Additional information on training may be found at Training.
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