59E-7  PATIENT DATA COLLECTION

59E-7.011 Definitions.

As used in Rules 59E-7.011 through 59E-7.016, F.A.C.:

(1) “Acute Care” means inpatient general routine care provided to patients who are in an acute phase of illness, which includes the concentrated and continuous observation and care provided in the intensive care units of an institution.

(2) “Charity” means medical care provided by a healthcare entity to a person who has insufficient resources or assets to pay for the medical care without utilizing resources which are required to meet the person’s basic need for food, shelter, and clothing. No patient shall be considered charity care whose family income, as applicable for (12) months preceding the determination, exceeds 150 percent of the federal poverty guidelines, unless the amount of health care charges due from the patient exceeds 25 percent of annual family income. However, in no case shall the hospital charges for a patient whose family income exceeds four times the federal poverty level for a family of four be considered charity. This is information which should be provided based on the patient’s status at time of reporting.

(3) “E-coding,” meaning Supplementary Classification of External Causes of Injury and Poisoning, ICD-9-CM, is to be reported in all cases where environmental events, circumstances, and conditions are the cause of injury, poisoning, and other adverse effects as specified in the ICD-9-CM manual and the conventions of coding.

(4) “Inpatient” means a patient who has an admission order given by a licensed physician or other individual who has been granted admitting privileges by the hospital. Observation patients are excluded unless they are admitted.

(5) “Newborn” means a newborn baby born within the facility or the initial admission of an infant to any acute care facility within 24 hours of birth.

Specific Authority 408.061(1)(e), 408.15(8) FS. Law Implemented 408.061 FS. History–New 12-15-96, Amended 7-11-01.

59E-7.012  Inpatient Data Reporting and Audit Procedures.

(1) Hospitals licensed under Chapter 395, F.S., except state-operated hospitals and specialty rehabilitation hospitals as defined in subparagraph 59A-3.252(1)(c)2., F.A.C. (hereinafter referred to as “hospital/hospitals”), in operation for all or any of the reporting periods described in subsection 59E-7.012(5), F.A.C., below, shall submit hospital inpatient discharge data to the Agency according to the provisions in Rules 59E-7.011 through 59E-7.016, F.A.C. The amendments appearing herein are effective with the report period starting January 1, 2006 except the provisions in paragraph 59E-7.014(2)(p), F.A.C., are effective with the report period starting January 1, 2007.

(2) Each hospital shall submit a separate report for each location per paragraph 59A-3.066(2)(i), F.A.C.

(3) All acute, intensive care, and psychiatric live discharges and deaths including newborn live discharges and deaths shall be reported. Submit one record per inpatient discharge, to include all newborn admissions, transfers and deaths.

(4) Upon notification by the AHCA Agency staff, all hospitals shall provide access to all required information from the medical records and billing documents underlying and documenting the hospital inpatient discharge reports submitted, as well as other inpatient related documentation deemed necessary to conduct successful inpatient data audits of hospital data, regardless of reporting format. No inpatient discharge records that support inpatient discharge data are exempt from disclosure to AHCA for audit purposes.

(5) All hospitals reporting their inpatient discharge data shall report according to the following schedule commencing with 1st quarter data 1997 (01/01/97-03/31/97):

(a) Each report submitted for the 1st quarter covering inpatient discharges occurring between January 1 and March 31, inclusive, of each year, shall be submitted no later than June 1 of the calendar year during which the discharge occurred. This is considered to be the first quarter, regardless of the hospital’s fiscal year.

(b) Each report submitted for the 2nd quarter covering inpatient discharges occurring between April 1 and June 30, inclusive, of each year, shall be submitted no later than September 1 of the calendar year during which the discharge occurred. This is considered to be the second quarter, regardless of the hospital’s fiscal year.

(c) Each report submitted for the 3rd quarter covering inpatient discharges occurring between July 1 and September 30, inclusive, of each year, shall be submitted no later than December 1 of the calendar year during which the discharge occurred. This is considered to be the third quarter, regardless of the hospital’s fiscal year.

(d) Each report submitted for the 4th quarter covering inpatient discharges occurring between October 1 and December 31, inclusive, of each year, shall be submitted no later than March 1 of the calendar year following the year in which the discharge occurred. This is considered to be the fourth quarter, regardless of the hospital’s fiscal year.

(6) Extensions to the initial submission due date will be granted by the Administrator, Office of Data Collection Section of the Agency staff, for a maximum of 30 days from the initial submission due date in response to a written request signed by the hospital’s chief executive officer or chief financial officer. The request must be received prior to the initial submission due date and the delay must be due to unforeseen and unforeseeable factors beyond the control of the reporting hospital. These factors must be specified in the written request for the extension along with documentation of efforts undertaken to meet the filing requirements. Extensions shall not be granted verbally.

(7) Failure to file the report on or before the due date without an extension, and failure to correct a report which has been filed but contains errors or deficiencies within 10 working days from notification of errors or deficiencies, is punishable by fine pursuant to Rule 59E-7.013, F.A.C. The agency shall send notification of errors or deficiencies by certified mail, electronic mail, or fax.

(8) Beginning with the inpatient data report for the 1st Quarter of the year 2006 (January 1, 2006 through March 31, 2006), reporting facilities shall submit inpatient discharge data by Internet according to the specifications in paragraphs (a) through (c) below unless reporting by CD-ROM is approved by the Agency in a case of extraordinary or hardship circumstances.

(a) The Internet address for the receipt of inpatient data is https://ahcaxnet.fdhc.state.fl.us/patientdata.

(b) Data submitted to the Internet address shall be electronically transmitted with the inpatient data in XML file using the Inpatient Data XML Schema available at http://ahca.myflorida.com/SCHS/hpdunit.shtml dated 11-01-06. The Inpatient Data XML Schema is incorporated by reference.

(c) The data in the XML file shall contain the data elements, codes, and standards required in Rules 59E-7.014 and 59E-7.016, F.A.C.

(9) All hospitals submitting data in compliance with Rules 59E-7.011 through 59E-7.014, F.A.C., shall certify that the data submitted for each quarter is accurate, complete, and verifiable using Certification Form for Inpatient Discharge Data, AHCA Form 4200-002, dated 10/93 and incorporated by reference. AHCA Form 4200-002 can be obtained from the Agency’s office at the Agency for Health Care Administration, Florida Center for Health Information and Policy Analysis, 2727 Mahan Drive, Building 3, Tallahassee, Florida 32308. The completed Certification Form for Inpatient Discharge Data shall be submitted to the Agency’s office at the above address or shall be submitted by electronic mail to SCHSdata@fdhc.state.fl.us using an Agency authorized digital signature.

(10) Hospitals not certified within six (6) calendar months following the last day of the reporting quarter shall be subject to penalties pursuant to Rule 59E-7.013, F.A.C. Extensions to this six (6) month period will not be granted.

(11) Changes or corrections to hospital data will be accepted from hospitals to improve their data quality for a period of eighteen (18) months following the initial submission of data. The Administrator, Office of Data Collection, may grant approval for resubmitting previously certified data in response to a written request signed by the hospital’s chief executive officer or chief financial officer. The reason for the changes or corrections must be specified in the written request. Any changes to a hospital’s data after this eighteen-month period shall be subject to penalties pursuant to Rule 59E-7.013, F.A.C.

(12) The agency shall to the extent practical, apply the same audit standards and use the same audit procedures for all hospitals or audit a random sample of hospitals. The agency will notify each hospital of any possible errors discovered by audit and request that the hospital either correct the data or verify that the data is complete and correct. The notice shall indicate that the hospital must return corrected data if there are errors and certify the data within ninety (90) days of receipt of the notice, or the hospital Chief Executive Officer must verify by signature that the previously submitted and certified data is complete and correct within ninety (90) days of receipt of the notice. The notice shall clearly indicate that the hospital may be subject to penalties pursuant to Rule 59E-7.013, F.A.C.

Specific Authority 408.08(1)(e), 408.15(8) FS. Law Implemented 408.061, 408.08(1), (2), 408.15(11) FS. History–New 12-15-96, Amended 1-4-00, 7-11-01, 7-12-05, 5-22-07.

59E-7.013 Penalties for Hospital Inpatient Discharge Data Reporting Discrepancies.

(1) For purposes of this rule, a report or other information is incomplete when it does not contain all data required by the Agency in this rule and in forms incorporated by reference or when it contains inaccurate data and the report is not corrected by the hospital and certified timely per Rule 59E-7.012, F.A.C. A report or other information is “false” if done or made with the knowledge of the preparer or an administrator that it contains information or data which is not true or accurate.

(2) A hospital which refuses to file, fails to timely file, or files false or incomplete reports or other information required to be filed under the provisions of s. 408.08(13), F.S., other Florida Law, or rules adopted thereunder, shall be subject to administrative penalties. Failure to comply with reporting requirements will also result in the referral of a hospital to the Agency’s Bureau of Health Facility Regulation.

(3) Delinquent report notices will be sent via certified mail to the attention of “Chief Executive Officer.”

(4) The penalty period will begin on the first working day following the due date for purposes of penalty assessments.

(5) In addition, any hospital which is delinquent for a reporting deficiency shall be subject to a fine of $100 per day of violation for the first violation, $350 per day of violation for the second violation, and $1000 per day of violation for the third and all subsequent violations. Violations will be considered those activities which necessitate the issuance of an administrative complaint by the agency unless the administrative complaint is withdrawn or final order dismissing the administrative complaint is entered. All fines are to be fixed, imposed, and collected by the Agency. Any hospital which files false information to the Agency shall be subject to a fine of $1000 per day, in addition to any other fine imposed hereunder. The fine shall be fixed, imposed, and collected by the Agency.

Specific Authority 408.061(1)(e), 408.15(8) FS. Law Implemented 408.08(13), (16) FS. History–New 12-15-96.

59E-7.014  Inpatient Data Format - Data Elements, Codes and Standards.

(1) HEADER RECORD. The first record in the data file shall be a header record containing the information described below.

(a) Transaction Code. Enter Q for a calendar quarter report or S for a report period other than a calendar quarter where the special report is requested or authorized by the Agency to receive data corrections. A required field.

(b) Report Year. Enter the year of the data in the format YYYY where YYYY represents the year in four (4) digits. A required field.

(c) Report Quarter. Enter the quarter of the data, 1, 2, 3 or 4, where 1 corresponds to the first quarter of the calendar year, 2 corresponds to the second quarter of the calendar year, 3 corresponds to the third quarter of the calendar year, and 4 corresponds to the fourth quarter of the calendar year. A required field.

(d) Data Type. Enter PD10-1 for Inpatient Data. A required field.

(e) Submission Type. Enter I or R where I indicates an initial submission or resubmission of previously rejected data, R indicates a replacement submission of previously processed and accepted inpatient data where resubmission has been requested or authorized by the Agency. A required field.

(f) Processing Date. Enter the date that the data file was created in the format YYYY-MM-DD where MM represents numbered months of the year from 01 to 12, DD represents numbered days of the month from 01 to 31, and YYYY represents the year in four (4) digits. A required field.

(g) AHCA Hospital Number. Enter the identification number of the hospital as assigned by AHCA for reporting purposes. A valid identification number must contain at least eight (8) digits and no more than twelve (12) digits. A required field.

(h) Organization Name. Enter the name of the hospital that performed the inpatient service(s) represented by the data, and which is responsible for reporting the data. All questions regarding data accuracy and integrity will be referred to this entity. Up to a forty-character field. A required field.

(i) Contact Person Name. Enter the name of the contact person for the hospital. Submit name in the Last, First format. Up to a twenty-five-character field. A required field.

(j) Contact Phone Number. The area code, business telephone number, and if applicable, extension for the contact person. Enter the contact person’s telephone number in the format (AAA)XXXXXXXEEEE where AAA is the area code, XXXXXXX represents the seven (7) digit phone number and EEEE represents the extension. Zero fill if no extension. A required field.

(k) Contact Person E-Mail Address. Enter the e-mail address of the contact person.

(l) Contact Person Street or P.O. Box Address. Enter the street or post office box address of the contact person’s mailing address. Up to a forty-character field. A required field.

(m) Mailing Address City. Enter the city of the contact person’s address. Up to a twenty-five character field. A required field.

(n) Mailing Address State. Enter the state of the contact person’s address using the U.S. Postal Service state abbreviation in the format XX. Use the abbreviation FL for Florida. A required field.

(o) Mailing Address Zip Code. Enter the zip code of the contact person’s address in the format XXXXX-XXXX.

(2) INDIVIDUAL DATA RECORDS. All data elements and data element codes listed below shall be reported consistent with the records of the reporting entity. Data elements and codes are listed with a description of the data to be reported and data standards.

(a) AHCA Hospital Number. Enter the identification number of the hospital as assigned by AHCA for reporting purposes. A valid identification number must contain at least eight (8) digits and no more than twelve (12) digits. A required field.

(b) Record Identification Number. An alpha-numeric code containing standard letters or numbers assigned by the facility as a unique identifier for each record submitted in the reporting period to facilitate storage and retrieval of individual case records. Up to seventeen (17) characters. Duplicate record identification numbers are not permitted. A required field. The hospital must maintain a key list to locate actual records upon request by AHCA.

(c) Patient Social Security Number. Enter the social security number (SSN) of the patient receiving treatment. The SSN is a nine (9) digit number issued by the Social Security Administration. Reporting 000000000 is acceptable for newborns and infants up to two (2) years of age at admission who do not have a SSN. Reporting 777777777 is acceptable for those patients where efforts to obtain the SSN have been unsuccessful and the patient is two (2) years of age or older and not known to be from a country other than the United States (U.S.). Reporting 555555555 is acceptable for non-U.S. citizens who have not been issued SSNs. One SSN; one inpatient. DO NOT share SSNs in this field. A required entry.

(d) Patient Race or Ethnicity. Self-designated by the patient or patient’s parent or guardian except code 8 indicating no response may be reported where efforts to obtain the information from the patient or from the patient’s parent or guardian have been unsuccessful. A required entry. Must be a one (1) digit code as follows:

1. 1– American Indian or Alaska Native

2. 2 – Asian or Pacific Islander

3. 3 – Black or African American

4. 4 – White

5. 5 – White Hispanic

6. 6 – Black Hispanic

7. 7 – Other-Use if the patient’s self-designated race or ethnicity is not described by the above categories.

8. 8 – No Response-Use if the patient refuses or fails to disclose.

(e) Patient Birth Date. The date of birth of the patient. A ten (10) character field in the format YYYY-MM-DD where MM represents the numbered months of the year from 01 to 12, DD represents numbered days of the month from 01 to 31, and YYYY represents the year in four (4) digits. Age greater than one hundred twenty (120) years is not permitted unless verified by the reporting entity. A birth date after the discharge date is not permitted. A required entry.

(f) Patient Gender. The gender of the patient at admission. A required entry. Must be a one (1) digit code as follows:

1. 1 – Male

2. 2 – Female

3. 3 – Unknown – Use where efforts to obtain the information have been unsuccessful or where the patient’s gender cannot be determined due to a medical condition.

(g) Patient Zip Code. The five (5) digit United States Postal Service ZIP Code of the patient’s permanent residence. Use 00009 for foreign residences. Use 00007 for homeless patients. Use 00000 where efforts to obtain the information have been unsuccessful. A required entry.

(h) Type of Admission. The scheduling priority of the admission. A required entry. Must be a one (1) digit code as follows:

1. 1 – Emergency – The patient requires immediate medical intervention as a result of severe, life- threatening or potentially disabling conditions.

2. 2 – Urgent – The patient requires attention for the care and treatment of a physical or mental disorder.

3. 3 – Elective – The patient’s condition permits adequate time to schedule the availability of a suitable accommodation.

4. 4 – Newborn – Use of this code requires the use of special Source of Admission codes. (See also subparagraphs 59E-7.014(2)(i)10.-13., F.A.C.)

5. 5 – Trauma Center – Trauma activation at a State of Florida designated trauma center.

(i) Source of Admission. Must be a two (2) digit code as follows, where codes 10 through 13 are to be used for newborn admissions, codes 1 through 8 are to be used for any admission that is not a newborn, code 9 is used where the source of admission is not known, and code 14 is used where the Source of Admission is other than code 1 through code 13. A required field.

1. 01 – Physician referral – The patient was admitted to this facility upon the recommendation of the patient’s personal physician.

2. 02 – Clinic referral – The patient was admitted to this facility upon recommendation of this facility’s clinic physician.

3. 03 – HMO referral – The patient was admitted to this facility upon the recommendation of a health maintenance organization physician.

4. 04 – Transfer from a hospital – The patient was admitted to this facility as a transfer from an acute care facility where the patient was an inpatient.

5. 05 – Transfer from a skilled nursing facility – The patient was admitted to this facility from a skilled nursing facility where the patient was at a skilled level of care.

6. 06 – Transfer from another health care facility – The patient was admitted to this facility as a transfer from a health care facility other than an acute care facility or a skilled nursing facility.

7. 07 – Emergency Room – The patient was admitted to this facility through the emergency room upon recommendation of an emergency room physician or other physician.

8. 08 – Court/Law Enforcement – The patient was admitted upon the direction of a court of law, or upon the request of a law enforcement agency representative.

9. 09 – Information Not Available – The means by which the patient was admitted to this hospital is not known.

Codes required for newborn admissions (Type of Admission=4):

10. 10 – Normal delivery – A baby delivered without complications.

11. 11 – Premature delivery – A baby delivered with time or weight factors qualifying it for premature status.

12. 12 – Sick Baby – A baby delivered with medical complications, other than those relating to premature status.

13. 13 – Extramural – A newborn born in a non-sterile environment.

14. 14 – Other – The source of admission is not described by subparagraphs 1. through 13., above.

(j) Admission Date. The date the patient was admitted to the reporting facility. A ten (10) character field in the format YYYY-MM-DD where MM represents the numbered months of the year from 01 to 12, DD represents numbered days of the month from 01 to 31, and YYYY represents the year in four (4) digits. Admission date must equal or precede the discharge date. A required entry.

(k) Discharge Date. The date the patient was discharged from the reporting facility. A ten (10) character field in the format YYYY-MM-DD where MM represents the numbered months of the year from 01 to 12, DD represents numbered days of the month from 01 to 31, and YYYY represents the year in four (4) digits. Discharge date must equal or follow the admission date, and discharge date must occur within the reporting period as shown on the header record. A required entry.

(l) Patient Discharge Status. Patient disposition at discharge. A required entry. Must be a two (2) digit code as follows:

1. 01 – Discharged to home or self-care (with or without planned outpatient medical care)

2. 02 – Discharged to a short-term general hospital

3. 03 – Discharged to a skilled nursing facility

4. 04 – Discharged to an intermediate care facility

5. 05 – Discharged to another type of institution (cancer or children’s hospital or distinct part unit)

6. 06 – Discharged to home under care of home health care organization

7. 07 – Left this hospital against medical advice (AMA) or discontinued care

8. 08 – Discharged home under care of home IV provider on IV medications

9. 20 – Expired

10. 50 – Discharged to hospice – home

11. 51 – Discharged to hospice – medical facility

12. 62 – Discharged to an inpatient rehabilitation facility including rehabilitation distinct part units of a hospital.

13. 63 – Discharged to a Medicare certified long term care hospital.

14. 65 – Discharged to a psychiatric hospital including psychiatric distinct part units of a hospital.

(m) Principal Payer Code. Describes the expected primary source of reimbursement for services rendered based on the patient’s status at discharge or the time of reporting. Report charity as defined in subsection 59E-7.011(2), F.A.C. A required entry. Must be a one (1) character alpha field using upper case as follows:

1. A – Medicare

2. B – Medicare HMO or Medicare PPO

3. C – Medicaid

4. D – Medicaid HMO

5. E – Commercial Insurance

6. F – Commercial HMO

7. G – Commercial PPO

8. H – Workers’ Compensation

9. I – CHAMPUS

10. J – VA

11. K – Other State/Local Government

12. L – Self Pay/Under-insured – No third party coverage or less than 30% estimated insurance coverage.

13. M – Other

14. N – Charity

15. O – KidCare – Includes Healthy Kids, MediKids and Children’s Medical Services.

(n) Principal Diagnosis Code. The code representing the diagnosis established, after study, to be chiefly responsible for occasioning the admission. Principal diagnosis code must contain a valid ICD-9-CM or ICD-10-CM code for the reporting period. Inconsistency between the principal diagnosis code and patient gender must be verified by the reporting entity. Inconsistency between the principal diagnosis code and patient age must be verified by the reporting entity. A diagnosis code cannot be used more than once as a principal or other diagnosis for each hospitalization reported. The code must be entered with a decimal point that is included in the valid code and without use of a zero or zeros that are not included in the valid code. A required entry.

(o) Other Diagnosis Code (1), Other Diagnosis Code (2), Other Diagnosis Code (3), Other Diagnosis Code (4), Other Diagnosis Code (5), Other Diagnosis Code (6), Other Diagnosis Code (7), Other Diagnosis Code (8), Other Diagnosis Code (9), Other Diagnosis Code (10), Other Diagnosis Code (11), Other Diagnosis Code (12), Other Diagnosis Code (13), Other Diagnosis Code (14), Other Diagnosis Code (15), Other Diagnosis Code (16), Other Diagnosis Code (17), Other Diagnosis Code (18), Other Diagnosis Code (19), Other Diagnosis Code (20), Other Diagnosis Code (21), Other Diagnosis Code (22), Other Diagnosis Code (23), Other Diagnosis Code (24), Other Diagnosis Code (25), Other Diagnosis Code (26), Other Diagnosis Code (27), Other Diagnosis Code (28), Other Diagnosis Code (29), and Other Diagnosis Code (30). A code representing a condition that is related to the services provided during the hospitalization excluding external cause of injury codes. Report external cause of injury codes as described in paragraph (ww) below. No more than thirty (30) other diagnosis codes may be reported. Less than thirty (30) entries or no entry is permitted consistent with the records of the reporting entity. Must contain a valid ICD-9-CM code or valid ICD-10-CM code for the reporting period. Inconsistency between the other diagnosis code and patient gender must be verified by the reporting entity. Inconsistency between the other diagnosis code and patient age must be verified by the reporting entity. An other diagnosis code cannot be used more than once as a principal or other diagnosis for each hospitalization reported. The code must be entered with use of a decimal point that is included in the valid code and without use of a zero or zeros that are not included in the valid code.

(p) Present on Admission Indicator for Principal Diagnosis Code, Present on Admission for Other Diagnosis Code (1), Present on Admission Indicator for Other Diagnosis Code (2), Present on Admission Indicator (3), Present on Admission Indicator for Other Diagnosis Code (4), Present on Admission Indicator for Other Diagnosis Code (5), Present on Admission Indicator for Other Diagnosis Code (6), Present on Admission Indicator for Other Diagnosis Code (7), Present on Admission Indicator for Other Diagnosis Code (8), Present on Admission Indicator for Other Diagnosis Code (9), Present on Admission Indicator for Other Diagnosis Code (10), Present on Admission Indicator for Other Diagnosis Code (11), Present on Admission Indicator for Other Diagnosis Code (12), Present on Admission Indicator for Other Diagnosis Code (13), Present on Admission Indicator for Other Diagnosis Code (14), Present on Admission Indicator for Other Diagnosis Code (15), Present on Admission Indicator for Other Diagnosis Code (16), Present on Admission Indicator for Other Diagnosis Code (17), Present on Admission Indicator for Other Diagnosis Code (18), Present on Admission Indicator for Other Diagnosis Code (19), Present on Admission Indicator for Other Diagnosis Code (20), Present on Admission Indicator for Other Diagnosis Code (21), Present on Admission Indicator for Other Diagnosis Code (22), Present on Admission Indicator for Other Diagnosis Code (23), Present on Admission Indicator for Other Diagnosis Code (24), Present on Admission Indicator for Other Diagnosis Code (25), Present on Admission Indicator for Other Diagnosis Code (26), Present on Admission Indicator for Other Diagnosis Code (27), Present on Admission Indicator for Other Diagnosis Code (28), Present on Admission Indicator for Other Diagnosis Code (29), Present on Admission Indicator for Other Diagnosis Code (30), Present on Admission Indicator for External Cause of Injury Code (1), Present on Admission Indicator for External Cause of Injury Code (2), and Present on Admission Indicator for External Cause of Injury Code (3). A code differentiating whether the condition represented by the corresponding Principal Diagnosis Code (n), Other Diagnosis Code (o)(1) through (30), and External Cause of Injury Code (ww)(1) through (3) was present on admission or whether the condition developed after admission as determined by the physician, medical record, or nature of the condition. A required entry if the corresponding code is reported or a blank field may be reported when present on admission is not applicable. Present on Admission Indicator must be a one (1) character alpha code as follows:

1. Y – Yes – Present at the time that the order for inpatient admission occurs.

2. N – No – Not present at the time that the order for inpatient admission occurs.

3. U – Unknown – Documentation is insufficient to determine if condition is present on admission.

4. W – Clinically Undetermined – Provider is unable to clinically determine whether condition was present on admission or not.

(q) Principal Procedure Code. The code representing the procedure most related to the principal diagnosis.  No entry is permitted consistent with the records of the reporting entity.  Must contain a valid ICD-9-CM or ICD-10-CM procedure code for the reporting period.  If a principal procedure date is reported, a valid principal procedure code must be reported.  Inconsistency between the principal procedure code and patient gender must be verified by the reporting entity.  Inconsistency between the principal procedure code and patient age must be verified by the reporting entity.  The code must be entered with use of a decimal point that is included in the valid code and without use of a zero or zeros that are not included in the valid code.

(r) Principal Procedure Date. The date when the principal procedure was performed.  If a principal procedure is reported, a principal procedure date must be reported. No entry is permitted if no principal procedure is reported. A ten (10)-character field in the format YYYY-MM-DD where MM represents the numbered months of the year from 01 to 12, DD represents numbered days of the month from 01 to 31, and YYYY represents the year in four (4) digits. The principal procedure date must be less than four (4) days prior to the admission date and not later than the discharge date.

(s) Other Procedure Code (1), Other Procedure Code (2), Other Procedure Code (3), Other Procedure Code (4), Other Procedure Code (5), Other Procedure Code (6), Other Procedure Code (7), Other Procedure Code (8), Other Procedure Code (9), Other Procedure Code (10), Other Procedure Code (11), Other Procedure Code (12), Other Procedure Code (13), Other Procedure Code (14), Other Procedure Code (15), Other Procedure Code (16), Other Procedure Code (17), Other Procedure Code (18), Other Procedure Code (19), Other Procedure Code (20), Other Procedure Code (21), Other Procedure Code (22), Other Procedure Code (23), Other Procedure Code (24), Other Procedure Code (25), Other Procedure Code (26), Other Procedure Code (27), Other Procedure Code (28), Other Procedure Code (29), and Other Procedure Code (30). A code representing a procedure provided during the hospitalization.  If no principal procedure is reported, an other procedure code must not be reported.  No more than thirty (30) other procedure codes may be reported. Less than thirty (30) or no entry is permitted consistent with the records of the reporting entity.  Must be a valid ICD-9-CM or ICD-10-CM procedure code for the reporting period. Inconsistency between the procedure code and patient gender must be verified by the reporting entity. Inconsistency between the procedure code and patient age must be verified by the reporting entity. The code must be entered with use of a decimal point that is included in the valid code and without use of a zero or zeros that are not included in the valid code.

(t) Other Procedure Code Date (1), Other Procedure Code Date (2), Other Procedure Code Date (3), Other Procedure Code Date (4), Other Procedure Code Date (5), Other Procedure Code Date (6), Other Procedure Code Date (7), Other Procedure Code Date (8), Other Procedure Code Date (9), Other Procedure Code Date (10), Other Procedure Code Date (11), Other Procedure Code Date (12), Other Procedure Code Date (13), Other Procedure Code Date (14), Other Procedure Code Date (15), Other Procedure Code Date (16), Other Procedure Code Date (17), Other Procedure Code Date (18), Other Procedure Code Date (19), Other Procedure Code Date (20), Other Procedure Code Date (21), Other Procedure Code Date (22), Other Procedure Code Date (23), Other Procedure Code Date (24), Other Procedure Code Date (25), Other Procedure Code Date (26), Other Procedure Code Date (27), Other Procedure Code Date (28), Other Procedure Code Date (29), and Other Procedure Code Date (30).  The date when the procedure was performed.  A required entry if a corresponding procedure code (s)(1) through (30) is reported.  No entry is permitted if no procedure is reported consistent with the records of the reporting entity.  A ten (10)-character field in the format YYYY-MM-DD where MM represents the numbered months of the year from 01 to 12, DD represents numbered days of the month from 01 to 31, and YYYY represents the year in four (4) digits.  The procedure date must be less than four (4) days prior to the admission date and not later than the discharge date.

(u) Attending Physician Identification Number. The Florida license number of the medical doctor, osteopathic physician, dentist, podiatrist, chiropractor, or advanced registered nurse practitioner who had primary responsibility for the patient’s medical care and treatment or who certified as to the medical necessity of the services rendered. For military physicians not licensed in Florida, use US.  A required entry.

(v) Operating or Performing Physician Identification Number. The Florida license number of the medical doctor, osteopathic physician, dentist, podiatrist, chiropractor, or advanced registered nurse practitioner who had primary responsibility for the principal procedure performed.  The operating or performing physician may be the attending physician.  For military physicians not licensed in Florida, use US.  No entry is permitted if no principal procedure is reported consistent with the records of the reporting entity.

(w) Other Operating or Performing Physician Identification Number. The Florida license number of a medical doctor, osteopathic physician, dentist, podiatrist, chiropractor, or advanced registered nurse practitioner who assisted the operating or performing physician or performed a secondary procedure. The other operating or performing physician must not be reported as the operating or performing physician.  The other operating or performing physician may be the attending physician. For military physicians not licensed in Florida, use US.  No entry is permitted consistent with the records of the reporting entity.

(x) Room and Board Charges. Routine service charges incurred for accommodations. Report charges for revenue codes 11X through 16X as used in the UB-92 or UB-04. Charges to be reported in dollars numerically, without dollar signs or commas, excluding cents. Report zero (0) if there are no Room and Board Charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.

(y) Nursery Charges. Accommodation charges for nursing care to newborn and premature infants in nursery.  Report charges for revenue code 17X as used in the UB-92 or UB-04 excluding Level III charges. Charges to be reported in dollars numerically, without dollar signs or commas, excluding cents. Report zero (0) if there are no Nursery Charges.  Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.

(z) Level III Nursery Charges. Accommodation charges for nursing care to newborn and premature infants for Level III nursery charges.  Report charges for revenue code 173 (Level III) as used in the UB-92 or UB-04. Charges to be reported in dollars numerically, without dollar signs or commas, excluding cents. Report zero (0) if there are no Level III Nursery Charges.  Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.

(aa) Intensive Care Charges. Routine service charges for medical or surgical care provided to patients who require a more intensive level of care than is rendered in the general medical or surgical unit. Exclude neonatal intensive care charges reported as a Level III Nursery Charge.  Report charges for revenue code 20X as used in the UB-92 or UB-04.  Reported in dollars numerically, without dollar signs or commas, excluding cents. Report zero (0) if there are no intensive care charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.

(bb) Coronary Care Charges. Routine service charges for medical care provided to patients with coronary illness who require a more intensive level of care than is rendered in the general medical unit. Report charges for revenue code 21X as used in the UB-92 or UB-04.  Reported in dollars numerically, without dollar signs or commas, excluding cents. Report zero (0) if there are no coronary care charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.

(cc) Pharmacy Charges. Charges for medication. Report charges for revenue codes 25X and 63X as used in the UB-92 or UB-04. Reported in dollars numerically without dollar signs or commas, excluding cents.  Report zero (0) if there are no pharmacy charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.

(dd) Medical and Surgical Supply Charges. Charges for supply items required for patient care. Report charges for revenue codes 27X and 62X as used in the UB-92 or UB-04. Reported in dollars numerically without dollar signs or commas, excluding cents. Report zero (0) if there are no medical and surgical supply charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.

(ee) Laboratory Charges. Charges for the performance of diagnostic and routine clinical laboratory tests and for diagnostic and routine tests in tissues and culture. Report charges for revenue codes 30X and 31X as used in the UB-92 or UB-04. Reported in dollars numerically without dollar signs or commas, excluding cents. Report zero (0) if there are no laboratory charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.

(ff) Radiology or Other Imaging Charges. Charges for the performance of diagnostic and therapeutic radiology services including computed tomography, mammography, magnetic resonance imaging, nuclear medicine, and chemotherapy administration of radioactive substances. Report charges for revenue codes 32X through 35X, 40X and 61X as used in the UB-92 or UB-04. Reported in dollars numerically without dollar signs or commas, excluding cents.  Report zero (0) if there are no radiology or other imaging charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.

(gg) Cardiology Charges. Facility charges for cardiac procedures rendered such as, but not limited to, heart catheterization or coronary angiography. Reported in dollars numerically without dollar signs or commas, excluding cents. Report charges for revenue code 48X as used in the UB-92 or UB-04.  Report zero (0) if there are no cardiology charges.  Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.

(hh) Respiratory Services or Pulmonary Function Charges. Charges for administration of oxygen, other inhalation services, and tests that evaluate the patient’s respiratory capacities. Report charges for revenue codes 41X and 46X as used in the UB-92 or UB-04. Reported in dollars numerically without dollar signs or commas, excluding cents. Report zero (0) if there are no respiratory service or pulmonary function charges.  Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.

(ii) Operating Room Charges. Charges for the use of the operating room. Report charges for revenue code 36X as used in the UB-92 or UB-04.  Reported in dollars numerically without dollar signs or commas, excluding cents. Report zero (0) if there are no operating room charges.  Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.

(jj)  Anesthesia Charges. Charges for anesthesia services by the facility. Report charges for revenue code 37X as used in the UB-92 or UB-04. Reported in dollars numerically without dollar signs or commas, excluding cents. Report zero (0) if there are no anesthesia charges.  Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.

(kk)  Recovery Room Charges.  Charges for the use of the recovery room. Report charges for revenue code 71X as used in the UB-92 or UB-04.  Reported in dollars numerically without dollar signs or commas, excluding cents. Report zero (0) if there are no recovery room charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.

(ll) Labor Room Charges. Charges for labor and delivery room services. Report charges for revenue code 72X as used in the UB-92 or UB-04. Reported in dollars numerically without dollar signs or commas, excluding cents. Report zero (0) if there are no labor room charges.  Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.

(mm) Emergency Room Charges. Charges for medical examinations and emergency treatment. Report charges for revenue code 45X as used in the UB-92 or UB-04. Reported in dollars numerically without dollar signs or commas, excluding cents. Report zero (0) if there are no emergency room charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.

(nn) Trauma Response Charges.  Charges for a trauma team activation. Report charges for revenue code 68X used in the UB-92 or UB-04. Reported in dollars numerically without dollar signs or commas, excluding cents. Report zero (0) if there are no trauma response charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.

(oo) Treatment or Observation Room Charges. Charges for use of a treatment room or for the room charge associated with observation services. Report charges for revenue code 76X as used in the UB-92 or UB-04. Reported in dollars numerically without dollar signs or commas, excluding cents. Report zero (0) if there are no treatment or observation room charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.

(pp) Behavioral Health Charges. Charges for behavioral health treatment and services. Report charges for revenue codes 90X though 91X and 100X as used in the UB-92 or UB-04. Reported in dollars numerically without dollar signs or commas, excluding cents.  Report zero (0) if there are no charges.  Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.

(qq) Oncology. Charges for treatment of tumors and related diseases. Excludes therapeutic radiology services reported in radiology and other imaging services (ff). Report charges for revenue code 28X as used in the UB-92 or UB-04. Reported in dollars numerically without dollar signs or commas, excluding cents. Report zero (0) if there are no oncology charges. Negative amounts are not permitted unless verified separately by the reporting entity.  A required entry.

(rr) Physical and Occupational Therapy Charges.  Report charges for physical, occupational or speech therapy in revenue codes 42X through 44X as used in the UB-92 or UB-04. Reported in dollars numerically without dollar signs or commas, excluding cents.  Report zero (0) if there are no charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.

(ss)  Other Charges. Other facility charges not included in paragraphs (x) to (rr) above. Include charges that are not reflected in any of the preceding specific revenue accounts in the UB-92 or UB-04. DO NOT include charges from revenue codes 96X, 97X, 98X, or 99X in the UB-92 or UB-04 for professional fees and personal convenience items. Reported in dollars numerically without dollar signs or commas, excluding cents.  Report zero (0) if there are no other charges.  Negative amounts are not permitted unless verified separately by the reporting entity.  A required entry.

(tt) Total Gross Charges. The total of undiscounted charges for services rendered by the hospital. Include charges for services rendered by the hospital excluding professional fees. The sum of all charges reported above in paragraphs (x) through (ss) must equal total charges, plus or minus ten (10) dollars. Reported in dollars numerically without dollar signs or commas, excluding cents. Zero (0) or negative amounts are not permitted unless verified separately by the reporting entity. A required entry.

(uu) Infant Linkage Identifier. The social security number of the patient’s birth mother where the patient is less than two (2) years of age.  A nine (9) digit field to facilitate retrieval of individual case records, to be used to link infant and mother records, and for medical research.  Reporting 777777777 for the mother’s SSN is acceptable for those patients where efforts to obtain the mother’s SSN have been unsuccessful and the mother is not known to be from a country other than the United States.  Reporting 555555555 is acceptable if the infant’s mother is not a U.S. Citizen and has not been issued a SSN. Infants in the custody of the State of Florida or adoptions, use 333333333 if the birth mother’s SSN is not available. A required field for patients whose age is less than two (2) years of age at admission.  If the patient is two (2) years of age or older, the field is zero filled.  A required entry.

(vv) Admitting Diagnosis.  The diagnosis provided by the admitting physician at the time of admission which describes the patient’s condition upon admission or purpose of admission. Must contain a valid ICD-9-CM code or valid ICD-10-CM code for the reporting period. Inconsistency between the admitting diagnosis code and patient gender must be verified by the reporting entity. Inconsistency between the admitting diagnosis code and patient age must be verified by the reporting entity.   The code must be entered with use of a decimal point that is included in the valid code and without use of a zero or zeros that are not included in the valid code. A required entry.

(ww) External Cause of Injury Code (1), External Cause of Injury Code (2), and External Cause of Injury Code (3). A code representing circumstances or conditions as the cause of the injury, poisoning, or other adverse effects recorded as a diagnosis. No more than three (3) external cause of injury codes may be reported.  Less than three (3) or no entry is permitted consistent with the records of the reporting entity. Entry must be a valid ICD-9-CM or ICD-10-CM cause of injury code for the reporting period. An external cause of injury code cannot be used more than once for each hospitalization reported. The code must be entered with use of a decimal point that is included in the valid code and without use of a zero or zeros that are not included in the valid code.

(xx) Emergency Department Hour of Arrival. The hour on a 24-hour clock during which the patient’s registration in the emergency department occurred. A required entry. Use 99 where the patient was not admitted through the emergency department or where efforts to obtain the information have been unsuccessful. Must be two (2) digits as follows:

1. 00 – 12:00 midnight to 12:59

2. 01 – 01:00 to 01:59

3. 02 – 02:00 to 02:59

4. 03 – 03:00 to 03:59

5. 04 – 04:00 to 04:59

6. 05 – 05:00 to 05:59

7. 06 – 06:00 to 06:59

8. 07 – 07:00 to 07:59

9. 08 – 08:00 to 08:59

10. 09 – 09:00 to 09:59

11. 10 – 10:00 to 10:59

12. 11 – 11:00 to 11:59

13. 12 – 12:00 noon to 12:59

14. 13 – 01:00 to 01:59

15. 14 – 02:00 to 02:59

16. 15 – 03:00 to 03:59

17. 16 – 04:00 to 04:59

18. 17 – 05:00 to 05:59

19. 18 – 06:00 to 06:59

20. 19 – 07:00 to 07:59

21. 20 – 08:00 to 08:59

22. 21 – 09:00 to 09:59

23. 22 – 10:00 to 10:59

24. 23 – 11:00 to 11:59

25. 99 – Unknown.

(3) TRAILER RECORD. The last record in the data file shall be a trailer record and must accompany each data set. Report only the total number of patient data records contained in the file, excluding header and trailer records.  The number entered must equal the number of records processed.

Specific Authority 408.061(1)(e), 408.15(8) FS. Law Implemented 408.061 FS. History–New 12-15-96, Amended 7-11-01. 7-12-05, 5-22-07.

59E-7.015 Public Records.

(1) Agency records, public records under Chapter 119, F.S. (Florida’s Public Records Law), are available for public inspection during normal business hours. Copies of such records may be obtained upon request and upon payment of the cost of copying.

(2) Patient-specific records collected by the Agency pursuant to Rules 59E-7.011-.016, F.A.C., are exempt from disclosure pursuant to Section 408.061(8), F.S., and shall not be released unless modified to protect patient confidentiality as described in paragraph (2)(a) below and released in the manner described in paragraphs (2)(c) and (2)(d).

(a) The patient-specific record shall be modified to protect patient confidentiality as follows:

1. Patient’s Record ID Number as assigned by the facility. Substitute Sequential Number.

2. Patient Social Security Number. Deleted. Indicators of readmission at any Florida reporting hospital within 30 days of discharge will be substituted when available.  Readmission data will not be released for any quarter until each subsequent quarter is 100 percent certified.

3. Patient Birth Date. Substitute Age in Years and an indicator of Age <29 Days.

4. Admission Date. Deleted.

5. Discharge Date. Length of Stay (LOS) will be substituted.

6. Principal Procedure Date. Days from Admission to Principal Procedure will be substituted.

7. Other Procedure Date. Days from Admission to Other Procedure will be substituted.

8. Infant Linkage ID. Deleted.

(b) A record linkage number shall be assigned which does not identify an individual patient and cannot reasonably be used to identify an individual patient through use of data available through the Agency for Health Care Administration, but which can be used for confidential data output for bona fide research purposes.

(c) The modified data records described in paragraph (2)(a) shall be released as a set of all records occurring in one calendar quarter based on date of discharge.

(d) The modified data described in paragraph (2)(a) shall be released in accordance with the Limited Data Set requirements of the federal Health Insurance Portability and Accountability Act and shall be made available on or after quarterly data has been certified as accurate by the  hospitals as required by Section 408.061(1)(a), F.S.

(3) Aggregate reports derived from patient-specific hospital records collected pursuant to Rules 59E-7.011-.016, F.A.C., are public records and shall be released as described in this rule, provided that the aggregate reports do not include the patient’s record ID number as assigned by the facility, patient social security number, record linkage number, patient birth date, admission date, discharge date, principal procedure date, other procedure date, or infant linkage identifier; and provided the aggregate reports contain the combination of five or more records for any data disclosed.

(4) Requests for inpatient data shall be submitted by users sufficiently in advance to permit the staff to respond without disruption of their duties.

Specific Authority 408.061(1)(e), 408.15(8) FS. Law Implemented 119.07(1)(a), (2)(a), 408.061(8) FS. History–New 12-15-96, Amended 7-12-05.

59E-7.016 General Provisions.

Hospitals submitting inpatient discharge data pursuant to the provisions contained in these rules shall be directed by the following specific general provisions for inpatient data reporting:

(1) Hospitals are not required nor expected to submit inpatient discharge data on inpatients undergoing rehabilitative therapy if the therapy is not directly related to specific acute care reasons for the hospitalization being reported, (e.g., conduct of initial rehabilitative therapy during the period of the acute care phase of treatment for a broken leg to facilitate inpatient post-discharge mobility). Any inpatient who is transferred or discharged from the acute care setting into a strictly rehabilitative therapy mode of treatment, must be dropped from acute care accountability regardless of the category of administrative movement of the inpatient’s records. Any rehabilitation other than acute care cause specific treatment of short term duration will be questioned, and will be dropped from the AHCA data base if not acute care therapy in the strictest sense. This definition is applicable regardless of whether an inpatient transfers into a hospital internal rehabilitation therapy unit licensed for that purpose, or into a freestanding unit for continued therapy. A “rule of thumb” definition for application is that if it is not in conjunction with the acute care phase of inpatient treatment in the hospital, it is not applicable as reportable treatment reported as Inpatient Discharge Data as established and required by this rule. See also separate rules regarding Comprehensive Rehabilitation Discharge Inpatient Data reporting.

(2) If inpatients are administratively transferred or formally discharged from the acute care setting into a distinct-part Medicare certified skilled nursing unit of a hospital, acute care accountability ceases at the time of discharge/transfer, and the inpatient must be carried as a sub-acute care inpatient in other reporting modes. Sub-acute care is not reported as a part of inpatient discharge data.

Specific Authority 408.061(1)(e), 408.15(8) FS. Law Implemented 408.061 FS. History–New 12-15-96, Amended 7-11-01, 7-12-05.

CHAPTER 59E-7  PART II DATA COLLECTION COMPREHENSIVE REHABILITATION

59E-7.201 Submission of Comprehensive Inpatient Rehabilitation Hospital Patient Data.

(1) All comprehensive inpatient rehabilitation hospitals, in operation for any of the reporting periods described in subsection 59E-7.202(1), F.A.C., below, shall submit hospital patient discharge data and reports to the agency.

(2) For purposes of submission of rehabilitation hospital patient data, a comprehensive inpatient rehabilitation hospital shall be any hospital licensed as a class III special rehabilitation hospital, with comprehensive medical rehabilitation beds, meeting the definition of “rehabilitation hospital” of subsections 59A-3.152(9) and 59A-3.168(1)-(5), F.A.C.

(3) All comprehensive inpatient rehabilitation hospitals shall make reasonably available for onsite inspection information from the medical records underlying, documenting, or supporting the patient data reports submitted by the hospital, as well as other patient related documentation deemed necessary to carry out the agency’s regulatory duties. Inspections will be made at reasonable times and under reasonable circumstances.

(4) All comprehensive inpatient medical rehabilitation hospital patient data collected under Part III of Chapter 59E-7, F.A.C., shall not include specific provider contract reimbursement information, and any such data shall be considered proprietary. However, such specific provider reimbursement data shall be reasonably available for onsite inspection necessary to carry out the agency’s regulatory duties. Any such data obtained by the agency as a result of onsite inspections may not be used by the state for purposes of direct provider contracting and shall not be disclosed to the public.

Specific Authority 408.15(8) FS. Law Implemented 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a) -(b), 408.061(2)-(3), 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.085 FS. History–New 3-31-94.

59E-7.202 Schedule for Submission of Patient Data and Extensions.

(1) The first report of comprehensive inpatient rehabilitation hospital patient data covering patient discharges occurring between July 1 and September 30, 1993 and between October 1 and December 31, 1993, shall be submitted no later than May 1, 1994. Subsequently, all comprehensive inpatient rehabilitation hospitals shall report according to the following schedule:

(a) Each report covering patient discharges occurring between January 1 and March 31, inclusive, of each year, shall be submitted no later than June 1 of the calendar year during which the discharge occurred. This is considered to be the first quarter, regardless of the hospital’s fiscal year.

(b) Each report covering patient discharges occurring between April 1 and June 30, inclusive, of each year, shall be submitted no later than September 1 of the calendar year during which the discharge occurred. This is considered to be the second quarter, regardless of the hospital’s fiscal year.

(c) Each report covering patient discharges occurring between July 1 and September 30, inclusive, of each year, shall be submitted no later than December 1 of the calendar year during which the discharge occurred. This is considered to be the third quarter, regardless of the hospital’s fiscal year.

(d) Each report covering patient discharges occurring between October 1 and December 31, inclusive, of each year, shall be submitted no later than March 1 of the calendar year following which the discharge occurred. This is considered to be the fourth quarter, regardless of the hospital’s fiscal year.

(2) Hospitals must certify each calendar quarter’s data at the time the report is submitted. This certification of data is pursuant to Rule 59E-7.204, F.A.C. Extensions to this period may be granted pursuant to Subsection (3).

(3) Extensions to processing due dates will be granted by the agency staff for a maximum of 10 working days from original submission due date in response to a written request by the hospital’s Chief Executive Officer if received prior to the due date and provided that the delay is due to unforeseen factors beyond the control of the reporting hospital. These factors must be specified in the letter requesting the extension together with documentation of efforts undertaken to meet the filing requirements.

(4) Failure to file the report on or before the due date without an extension, and failure to correct a report which has been filed but contains errors or deficiencies within 10 days from notification of errors or deficiencies, is punishable by a fine pursuant to Rules 59E-2.024 and 59E-2.025, F.A.C.

Specific Authority 408.15(8) FS. Law Implemented 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a)-(b), 408.061(2)-(3), 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.08(9), 408.085 FS. History–New 3-31-94.

59E-7.203 Reporting Instructions.

The following instructions apply to comprehensive inpatient rehabilitation hospitals reporting in the tape/diskette format pursuant to Rule 59E-7.205, F.A.C., Patient Data Format – Data Elements and Codes:

(1) Submit agency rehabilitation patient data reports according to the agency data format only (See Rule 59E-7.205, F.A.C., Patient Data Format – Data Elements and Codes).

(2) All inpatient rehabilitation discharges or deaths shall be reported.

(3) Tape/Diskette specifications are:

(a) Tape:

1. Density – 1600 or 6250 BPI, 9 track

2. Collating Sequence – EBCDIC or ASCII.

3. Data Record Length – 320 characters, fixed

4. Blocking – Unblocked

5. Labeling – Standard IBM label (non-labeled tapes are accepted)

(b) Diskette:

1. MS-DOS formatted

2. PC Text File (ASCII)

3. Record Length – 320 characters, fixed

4. 51/4´´ diskette, 1.2 MB, MD2HD or

5. 3.5´´ diskette, 1.4 MB, MF2HD

6. FILENAME:(e.g., 1QTR92.TXT)

The first position must be a number from 1 through 4 indicating the quarter of the data submitted, followed by “QTR” in the second through fourth positions. The fifth and sixth positions indicate the calendar year of the data submitted. The seventh position is a period. The eighth through tenth positions are “TXT” which indicates a text file, (see example in 6. above).

(4) Hospitals shall submit tapes or diskettes, with the following external identification affixed via a label:

(a) Hospital Name

(b) AHCA Number in the AHCA 6 digit format

(c) Reporting period for discharges

(d) Number of records

(e) Tape Density: 1600/6250 BPI

(f) Collating Sequence: (TAPES)

(g) Filename: (DISKETTES) As in 7.203(3)(b)6. above

(h) Capacity: 1.2 MB or 1.4 MB (DISKETTES)

(i) The Description: “Comprehensive Inpatient Rehabilitation Patient Data”

(5) Submit one record per discharge.

(6) The data report, when submitted on tape or diskette, shall be accompanied by an agency Data File Submission Form, number AHCA-2000-MIS-93-01, which was adopted by the agency January 4, 1993 and is incorporated by reference to this rule, indicating name and AHCA number of the hospital, and the name and telephone number of the individual to contact in case of any problems with the data. Form AHCA-2000-MIS-93-01 can be obtained from The Agency for Health Care Administration, Florida Center for Health Information and Policy Analysis, Hospital Patient Data Section, 325 John Knox Road, Suite 301 the Atrium, Tallahassee, Florida 32303, (850) 488-1295. Electronically transmitted data will be accompanied by a file containing the same information.

Specific Authority 408.15(8) FS. Law Implemented 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a)-(b), 408.061(2)-(3), 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.085 FS. History–New 3-31-94.

59E-7.204 Certification Procedures.

(1) All hospitals submitting data in compliance with Rules 59E-7.201-7.208, F.A.C., shall certify that the data submitted for each quarter is accurate using form number AHCA-4200-0003-10/93, Rehabilitation Hospital Patient Data Report Certification Form, which was adopted by the agency October 22, 1993 and is incorporated by reference to this rule.

(2) The Chief Executive Officer and Chief Financial Officer shall certify in writing that a complete review was accomplished to assure the accuracy of the report and that to the best of their knowledge and belief, the data submitted are accurate and complete.

(3) Each hospital must certify each calendar quarter’s data at the time that the data are submitted pursuant to Rule 59E-7.202, F.A.C. Extensions to this period will not be permitted.

(4) Form AHCA-4200-0003-10/93 can be obtained from the agency’s office at The Agency for Health Care Administration, Florida Center for Health Information and Policy Analysis, Hospital Patient Data Section, 325 John Knox Road, 301 The Atrium, Tallahassee, Florida, 32303, (850) 488-1295.

Specific Authority 408.15(8) FS. Law Implemented 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a)-(b), 408.061(2)-(3), 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.08(9), 408.085 FS. History–New 3-31-94.

59E-7.205 Patient Data Format - Data Elements and Codes.

(1) HEADER RECORD:

The first record in the data file shall be a header record with a logical record length of 320 characters, containing the following information in the prescribed format.

        DATA ELEMENT                                                                       DESCRIPTION

        (a) Transaction Code                                                                  “H” for header record in the first position.

        (b) Reporting Year                                                                       A 4 digit field specifying the year of the

                                                                                                                data.

        (c) Reporting Quarter                                                                  A 1 digit field specifying the quarter that

                                                                                                                the data pertains to:

                                                                                                                1 = Jan. 1 through Mar. 31

                                                                                                                2 = Apr. 1 through Jun. 30

                                                                                                                3 = Jul. 1 through Sep. 30

                                                                                                                4 = Oct. 1 through Dec. 31

        (d) Data Type                                                                               “CR100” to specify comprehensive

                                                                                                                inpatient rehabilitation patient data.

        (e) Submission Type                                                                   A 1 character field for submission type:

                                                                                                                I = Initial. This is the first submission for

                                                                                                                the time period. All data set action codes

                                                                                                                must be “A”. This code is also used when

                                                                                                                replacing previously rejected files.

                                                                                                                M = Maintenance. All submissions which

                                                                                                                are not “I” or “R”. Data set action codes

                                                                                                                must be “A”, “D” or “U”.

                                                                                                                R = Re-submission. This code is used to

                                                                                                                replace all accepted or partially accepted

                                                                                                                records for the specified time period. All

                                                                                                                data set action codes must be “A”. All

                                                                                                                existing data for the time period will be

                                                                                                                deleted and replaced with the new data set.

        (f) Processing Date                                                                      CCYYMMDD, the date that the data file

                                                                                                                was created by the submitter.

        (g) AHCA Number                                                                      A 6 digit hospital identification number

                                                                                                                assigned by AHCA for reporting purposes.

        (h) Florida License Number                                                       A 10 digit license number assigned by

                                                                                                                AHCA Division of Health Quality

                                                                                                                Assurance.

        (i) Provider Medicaid Number                                                   A 7 digit number provided for Medicaid

                                                                                                                providers. If not a Medicaid provider, zero

                                                                                                                fill.

        (j) Provider Medicare Number                                                  A 7 digit number provided for Medicare

                                                                                                                providers. If not Medicare provider, zero

                                                                                                                fill.

        (k) Provider Organization Name                                               The name of the Comprehensive Inpatient

                                                                                                                Rehabilitation Hospital reporting the

                                                                                                                patient data records.

        (l) Provider Contact Person Name                                            The name of the contact person at the

                                                                                                                Comprehensive Inpatient Rehabilitation

                                                                                                                Hospital providing the patient data records.

        (m) Provider Contact Person Telephone                                 The area code, telephone number, and if

                                                                                                                Numberrequired, extension for the contact person

                                                                                                                at the Comprehensive Inpatient

                                                                                                                Rehabilitation Hospital providing the

                                                                                                                patient data records.

        (n) Submitter Organization Name                                            The name of the organization that

                                                                                                                produced the data file

                                                                                                                that is being submitted.

        (o) Submitter Contact Person Name                                        The name of the person at the submitting

                                                                                                                organization responsible for submitting the

                                                                                                                data file.

        (p) Submitter Contact Person Telephone                                The area code, telephone number, and if

                                                                                                                Numberrequired, extension for the contact person

                                                                                                                at the organization submitting the data file.

        (q) Filler                                                                                         A field of 102 spaces, to be left blank.

(2) INDIVIDUAL DATA RECORDS:

        DATA ELEMENT                                                                       DESCRIPTION

        (a) Data Type                                                                               “CR100” for all Comprehensive Inpatient

                                                                                                                Rehabilitation Hospital Patient Data.

        (b) Action Code                                                                           A 1 character field identifying type of

                                                                                                                record:

                                                                                                                A – Add New Record

                                                                                                                U – Update Existing Record

                                                                                                                D – Delete Existing Record

        (c) Reporting Quarter                                                                  A 1 digit field specifying the quarter that

                                                                                                                the data pertains to:

                                                                                                                1 – Jan. 1 through Mar. 31

                                                                                                                2 – Apr. 1 through Jun. 30

                                                                                                                3 – Jul. 1 through Sep. 30

                                                                                                                4 – Oct. 1 through Dec. 31

        (d) Reporting Year                                                                       CCYY, a 4 digit field.

        (e) AHCA Number                                                                      A 6 digit hospital identification number

                                                                                                                assigned by AHCA for reporting purposes.

        (f) Date Submitted                                                                      CCYYMMDD, an 8 digit field.

        (g) Reserved Field                                                                        Left blank, 20 spaces.

        (h) Record Identification Code                                                 A 17 character alpha-numeric code

                                                                                                                assigned by the hospital at the time of

                                                                                                                reporting as a unique identifier for each

                                                                                                                record submitted for each reporting period,

                                                                                                                to facilitate storage and retrieval of

                                                                                                                individual case records.

        (i) Patient Social Security Number                                           The social security number of the patient

                                                                                                                who received the treatment/services during

                                                                                                                this hospital stay. A 9 digit field to

                                                                                                                facilitate retrieval of individual case

                                                                                                                records, to be used to track patient

                                                                                                                readmissions, and for patient outcomes

                                                                                                                research. Fill with all zeros if not available.

        (j) Patient Racial Background                                                  A 1 digit code as follows:

                                                                                                                1 – American Indian/Eskimo/Aleut

                                                                                                                2 – Asian or Pacific Islander

                                                                                                                3 – Black

                                                                                                                4 – White

                                                                                                                5 – White Hispanic

                                                                                                                6 – Black Hispanic

                                                                                                                7 – Other

                                                                                                                8 – No Response

        (k) Patient Birth Date                                                                  CCYYMMDD, an 8 digit field.

        (l) Patient Sex                                                                               A 1 digit code as follows:

                                                                                                                1 – Male

                                                                                                                2 – Female

        (m) Patient Zip Code                                                                  A 5 digit zip code of the patient’s

                                                                                                                permanent address. use 00009 for foreign

                                                                                                                patients who do not have a resident zip

                                                                                                                code. use 00000 if unknown.

        (n) Source of Admission                                                             A 1 digit code as follows:

                                                                                                                1 – Physician Referral

                                                                                                                2 – Clinic Referral

                                                                                                                3 – HMO Referral

                                                                                                                4 – Transfer from a hospital

                                                                                                                5 – Transfer from a skilled nursing facility

                                                                                                                6 – Transfer from another health care facility

                                                                                                                7 – Emergency Room

                                                                                                                8 – Court/Law Enforcement

                                                                                                                9 – Other

        (o) Admission Date                                                                     CCYYMMDD, an 8 digit field.

        (p) Discharge Date                                                                       CCYYMMDD, an 8 digit field.

        (q) Patient Discharge Status                                                      A 2 digit code as follows:

                                                                                                                01 – Discharged home

                                                                                                                02 – Discharged to a short term general hospital

                                                                                                                03 – Discharged to a skilled nursing facility

                                                                                                                04 – Discharged to an intermediate care facility

                                                                                                                05 – Discharged to another type of institution

                                                                                                                06 – Discharged to home under care of home

                                                                                                                health care organization

                                                                                                                07 – Left against medical advice

                                                                                                                08 – Home on IV medications

                                                                                                                20 – Expired

        (r) Principal Payer Code                                                             A 1 character field as follows:

                                                                                                                A – Medicare

                                                                                                                B – Medicare HMO

                                                                                                                C – Medicaid

                                                                                                                D – Medicaid HMO

                                                                                                                E – Commercial Insurance

                                                                                                                F – Commercial HMO

                                                                                                                G – Commercial PPO

                                                                                                                H – Workers’ Compensation

                                                                                                                I – Champus

                                                                                                                J – VA

                                                                                                                K – Other

                                                                                                                State/Local

                                                                                                                Government

                                                                                                                L – Self Pay (No third party coverage)

                                                                                                                M – Other

        (s) Primary Condition Code                                                       The code is for the primary condition

                                                                                                                requiring treatment. Primary condition,

                                                                                                                established after study is found to be

                                                                                                                chiefly responsible for occasioning the

                                                                                                                admission of the patient to the hospital for

                                                                                                                inpatient rehabilitation services. A 2 digit

                                                                                                                code:

                                                                                                                01 – Stroke

                                                                                                                02 – Spinal Cord Injury

                                                                                                                03 – Congenital Deformity

                                                                                                                04 – Amputation

                                                                                                                05 – Major Multiple Trauma

                                                                                                                06 – Fracture of the femur (hip fracture)

                                                                                                                07 – Brain Injury

                                                                                                                08 – Poly-arthritis, including Rheumatoid

                                                                                                                arthritis

                                                                                                                09 – Neurological disorders, including

                                                                                                                multiple sclerosis, motor neuron diseases,

                                                                                                                polyneuropathy, muscular dystrophy and

                                                                                                                Parkinson’s disease.

                                                                                                                10 – Burns

                                                                                                                11 – All conditions requiring intensive

                                                                                                                rehabilitation services not assigned to

                                                                                                                categories 01-10

        (t) Attending Physician Identification                                     The physician’s Florida License

        Number                                                                                         Identification Number as assigned by the

                                                                                                                Department of Business and Professional

                                                                                                                Regulation. This is the physician who

                                                                                                                would normally be expected to have the

                                                                                                                primary responsibility for the patient’s care

                                                                                                                and treatment, or who certifies the

                                                                                                                comprehensive rehabilitation treatment. An

                                                                                                                11 character alpha-numeric field.

        (u) Total Gross Charges                                                              A required field up to 7 digits. Total dollars

                                                                                                                charged to the patient (before any

                                                                                                                discounts), rounded to the nearest dollar.

                                                                                                                No negative numbers.

        (v) Status Code                                                                            For agency use only. One space, to be left

                                                                                                                blank.

        (w) Reserved Filler                                                                       For agency use only, 193 spaces to be left

                                                                                                                blank. Errors in the record will be

                                                                                                                identified in this field by the agency.

        (3) TRAILER RECORD:

        DATA ELEMENT                                                                       DESCRIPTION

        (a) Transaction Code                                                                  “T” for the trailer record.

        (b) AHCA Number                                                                      A 6 digit hospital identification number

                                                                                                                assigned by AHCA for reporting purposes.

        (c) Florida License Number                                                       A 10 digit license number assigned by the

                                                                                                                AHCA Division of Health Quality

                                                                                                                Assurance.

        (d) Provider Medicaid Number                                                 A 7 digit number provided for Medicaid

                                                                                                                providers. If not a Medicaid provider, zero

                                                                                                                fill.

        (e) Provider Medicare Number                                                  A 7 digit number provided for Medicare

                                                                                                                providers. If not Medicare provider, zero

                                                                                                                fill.

        (f) Provider Mailing Address                                                      The address of the Comprehensive

                                                                                                                Inpatient Rehabilitation Hospital providing

                                                                                                                the patient data records.

        (g) Provider Mailing Address City                                             The city of the address of the

                                                                                                                Comprehensive Inpatient Rehabilitation

                                                                                                                Hospital providing the patient data records.

        (h) Provider Mailing Address State                                           The State of the Comprehensive Inpatient

                                                                                                                Rehabilitation Hospital providing the

                                                                                                                patient data records.

        (i) Provider Mailing Address Zip Code                                     The Zip Code of the Comprehensive

                                                                                                                Inpatient Rehabilitation Hospital providing

                                                                                                                the patient data records.

        (j) Submitter Mailing Address                                                   The address of the organization that is

                                                                                                                submitting the data file.

        (k) Submitter Mailing Address City                                          The City of the organization that is

                                                                                                                submitting the data file.

        (l) Submitter Mailing Address State                                         The state of the organization submitting the

                                                                                                                data file.

        (m) Submitter Mailing Address Zip Code                               The zip code of the organization

                                                                                                                submitting the data file.

        (n) Number of Records                                                               The total number of patient data records

                                                                                                                contained in the file, excluding header and

                                                                                                                trailer records.

        (o) Filler                                                                                         A blank field of 126 spaces.

Specific Authority 408.15(8) FS. Law Implemented 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a)-(b), 408.061(2)-(3), 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.085 FS. History–New 3-31-94.

59E-7.206 Patient Data Format - Record Layout.

(1) Header Record Layout. Each data file must contain as the first record a header record with a logical record length of 320 characters with the following record layout.

        DESCRIPTION                                                                   LENGTH               TYPE                POSITIONS              COMMENTS

(a) TRANSACTION CODE1A/N1MUST BE “H”

(b) REPORTING YEAR4N2 – 5CCYY

(c) REPORTING QUARTER1N61, 2, 3, or 4

(d) DATE TYPE5A/N7 – 11MUST BE “CR100”

(e) SUBMISSION TYPE1A12I, M, or R

(f) PROCESSING DATE8N13 – 20CCYYMMDD

(g) AHCA NUMBER10N21 – 30RIGHT JUSTIFY

(h) FLORIDA LICENSE NUMBER10A/N31 – 40LEFT JUSTIFY

(i) PROVIDER MEDICAID10A/N41 – 50LEFT JUSTIFY

NUMBER

(j) PROVIDER MEDICARE10A/N51 – 60LEFT JUSTIFY

NUMBER

(k) PROVIDER ORGANIZATION40A/N61 – 100LEFT JUSTIFY

NAME

(l) PROVIDER CONTACT25A/N101 – 125LEFT JUSTIFY

PERSON NAME

(m) PROVIDER CONTACT14N126 – 139LEFT JUSTIFY

PERSON TELEPHONE NUMBER

(n) SUBMITTER40A/N140 – 179LEFT JUSTIFY

ORGANIZATION NAME

(o) SUBMITTER CONTACT25A/N180 – 204LEFT JUSTIFY

        PERSON NAME

        (p) SUBMITTER CONTACT                                                 14                         N                     205 – 218              LEFT JUSTIFY

PERSON TELEPHONE NUMBER

(q) FILLER102A/N219 – 320BLANK SPACES

(2) Rehabilitation Patient Data Record Layout. The data elements for each patient record must have a logical record length of 320 characters with the following record layout.

        DESCRIPTION                                                                   LENGTH               TYPE                POSITIONS              COMMENTS

(a) DATA TYPE5A/N1 – 5“CR100”

(b) ACTION CODE1A6A, U, or D

(c) REPORTING QUARTER1N71, 2, 3 or 4

(d) REPORTING YEAR4N8 – 11CCYY

(e) AHCA NUMBER6N12 – 17RIGHT JUSTIFY

(f) DATE SUBMITTED8N18 – 25CCYYMMDD

(g) RESERVED FIELD20N26 – 45LEFT BLANK

(h) RECORD IDENTIFICATION CODE17A/N46 – 62RIGHT

JUSTIFIED

(i) PATIENT SOCIAL SECURITY9N63 – 71–

NUMBER

(j) PATIENT RACIAL1N72–

        BACKGROUND

        (k) PATIENT BIRTH DATE                                                    8                          N                        73 – 80                  CCYYMMDD

(l) PATIENT SEX1N811 or 2

(m) PATIENT ZIP CODE5N82 – 86–

(n) SOURCE OF ADMISSION1N87–

(o) ADMISSION DATE8N88 – 95CCYYMMDD

(p) DISCHARGE DATE8N96 – 103CCYYMMDD

(q) PATIENT DISCHARGE2N104 – 105–

STATUS

(r) PRINCIPAL PAYER CODE1A106–

(s) PRIMARY CONDITION CODE2N107 – 108–

(t) ATTENDING PHYSICIAN LICENSE11A/N109 – 119FLORIDA

IDENTIFICATION NUMBER

(u) TOTAL GROSS CHARGES7N120 – 126RIGHT

JUSTIFIED

(v) STATUS CODE1A127SPACE

(w) RESERVED FILLER193A/N128 – 320SPACES

(3) Trailer Record Layout. Each data file must contain as the last record, a trailer record with a logical record length of 320 characters with the following record layout.

        DESCRIPTION                                                                   LENGTH               TYPE                POSITIONS              COMMENTS

(a) TRANSACTION CODE1A/N1MUST BE “T”

(b) AHCA NUMBER10N2 – 11RIGHT JUSTIFY

(c) FLORIDA LICENSE NUMBER10A/N12 – 21–

(d) PROVIDER MEDICAID10A/N22 – 31LEFT JUSTIFY

NUMBER

(e) PROVIDER MEDICARE10A/N32 – 41LEFT JUSTIFY

NUMBER

(f) PROVIDER MAILING40A/N42 – 81LEFT JUSTIFY

ADDRESS

(g) PROVIDER MAILING25A/N82 – 106LEFT JUSTIFY

ADDRESS CITY

(h) PROVIDER MAILING2A107 – 108–

ADDRESS STATE

(i) PROVIDER MAILING5N109 – 113–

ADDRESS ZIP CODE

(j) SUBMITTER MAILING40A/N114 – 153LEFT JUSTIFY

ADDRESS

(k) SUBMITTER MAILING25A/N154 – 178LEFT JUSTIFY

ADDRESS CITY

(l) SUBMITTER MAILING2A179-180–

ADDRESS STATE

(m) SUBMITTER MAILING5N181-185–

ADDRESS ZIP CODE

(n) NUMBER OF RECORDS9N186-194COUNT

EXCLUDES

HEADER AND

TRAILER RECORDS

(o) FILLER126A/N195-320BLANK SPACES

Specific Authority 408.15(8) FS. Law Implemented 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a)-(b), 408.061(2)-(3), 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.085 FS. History–New 3-31-94.

59E-7.207 Data Standards.

Hospitals submitting pursuant to Rule 59E-7.207, F.A.C., shall report data according to the following parameters:

(1) Header Record:

(a) The Transaction Code must be “H”.

(b) The Reporting Year must be included or the record will be rejected.

(c) The Reporting Quarter must be 1, 2, 3, or 4.

(d) The Data Type must be “CR100”

(e) The Submission Type must be I, M, or R.

(f) The Processing Date should reflect the date that the data file was created by the submitter.

(g) The AHCA Number must be valid for the facility or the file will be REJECTED.

(h) The Florida License Number must be valid for the facility as licensed by the AHCA Division of Health Quality Assurance.

(i) The Provider Medicaid Number must be valid for the facility. If the facility is not a Medicaid provider, zero fill this field.

(j) The Provider Medicare Number must be valid for this facility. If the facility is not a Medicare provider, zero fill this field.

(k) The Provider Organization Name is the name of the health care provider that the data file reflects.

(l) The Provider Contact Person Name and Telephone Number specify the contact individual at the health care provider organization.

(m) The Submitter Organization Name is the name of the organization that produced the data file being submitted.

(n) The Submitter Contact Person Name and Telephone Number specify a contact person at the submitting organization.

(2) Comprehensive Inpatient Rehabilitation Hospital Patient Data Records:

(a) The Data Type must be “CR100”, is a required field for each comprehensive inpatient rehabilitation hospital patient data record, and is the first element in each record.

(b) The Action Code must be included for each record or the entire record will be REJECTED.

(c) The Reporting Quarter must be included for each record or the record will be REJECTED.

(d) The Reporting Year must be included for each record or the record will be REJECTED.

(e) The AHCA Number is a required field for each comprehensive inpatient rehabilitation hospital patient data record; must be 6 digits; and must be included on the tape/diskette external label or the entire file will be REJECTED.

(f) The Date Submitted must be included in each record or the record will be REJECTED.

(g) The Reserved Field is to be left blank for agency use.

(h) The Record Identification Code must be provided, each must be a unique identifier, up to 17 characters, and cannot be all spaces. Failure to provide a record identification code will result in REJECTION of the record. Duplication of a record identification code will also result in REJECTION of the record, with the exception of revisions to previously submitted reports, in which case the revised record must have a more current submission date and must have an Action Code of “U”, indicating that this is an update.

(i) The Patient Social Security number is a 9 digit required field for all patients who have had social security numbers assigned. Those not having social security numbers are expected to be newborn up to two years of age, or foreign or elderly patients who have never had one assigned. If not available, zero fill this field.

(j) The Patient Racial Background is a single digit entry showing: 1 – American Indian/Eskimo/Aleut, 2 – Asian/Pacific Islander, 3 – Black, 4 – White, 5 – White Hispanic, 6 – Black Hispanic, 7 – Other, 8 – No Response; For use as demographic and epidemiological information, and health planning.

(k) The Patient Birth Date is required; must be 8 digits; month must be 01-12; day must be 01-31; and year must be a 4 digit numeric character (e.g., 1963).

(l) The Patient Sex designation must be 1 or 2.

(m) The Patient Zip Code is required and must be 5 digits. use 00009 for foreign patients who do not have a zip code for residence. use 00000 if unknown.

(n) The Source of Admission is required; must be 1-9.

(o) The Admission Date is required; must be 8 digits; month must be 01-12; day must be 01-31; and year must be a four digit numeric character (e.g., 1994). The Admission Date must be equal to or precede the Discharge Date.

(p) The Discharge Date is required; must be 8 digits; month must be 01-12; day must be 01-31; and year must be a four digit numeric character (e.g., 1994). The Discharge Date must occur within the specified reporting period as shown on the external label of the tape/diskette: (e.g., 01/01-03/31, 04/01-06/30, 07/01-09/30, 10/01-12/31).

(q) The Patient Discharge Status is required; must be 2 digits; and must be 01-08 or 20.

(r) The Principal Payer Code is required and must be an alphabetic character A through M.

(s) The Primary Condition Code is required and must be a valid code 01-11. The leading zero is required for 01-09. The primary condition reported should be in accordance with the primary diagnosis reported to the Health Care Financing Administration (HCFA). Failure to provide primary condition will result in REJECTION of the record.

(t) The Attending Physician Identification Number is a required entry showing the Florida license number of the physician having primary responsibility for the patient’s care and treatment.

(u) The Total Gross Charges field is required; must be rounded to the nearest dollar; and must be numeric. A space filled field is not acceptable. A zero filled gross charge is only acceptable if the Discharge Status is 02 (Discharged to short term general hospital), 05 (discharged to another type of institution), or 20 (expired). Since all charges are rounded to the nearest dollar, an allowance for rounding will be accepted.

(v) The Status Code field must be left blank. It will be used by the agency, internally and in a report to the provider, to indicate whether the record has been accepted or rejected.

(w) The Reserved Filler field is to be left blank. This field will be used by the agency, internally and in a report to the provider, to indicate specific errors within the record.

(x) The total discharges reported must equal total discharges for calendar quarter stated on external tape/diskette label, and on the trailer record.

(3) Trailer Record:

(a) The Transaction Code must be “T”.

(b) The AHCA Number, as issued by AHCA, must be valid for the health care provider facility.

(c) The Florida License Number must be currently valid for the facility licensed by the AHCA Division of Health Quality Assurance.

(d) The Provider Medicaid Number must be the correct number issued to the health care facility.

(e) The Provider Medicare Number must be the correct number issued to the health care facility.

(f) The Provider Address fields specify where correspondence and data files should be sent to the health care provider.

(g) The Submitter Address fields specify where correspondence and data files should be sent to the submitter organization.

(h) The Number of Records must equal the number of patient data records physically on the data exchange file, excluding the header and trailer records.

(i) The Filler field is to be left blank.

Specific Authority 408.15(8) FS. Law Implemented 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a)-(b), 408.061(2)-(3), 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.085 FS. History–New 3-31-94.

59E-7.208 Notice of Potential Future Additional Data Requirements.

The agency intends to develop additional data requirements and implementation schedules after it receives and analyzes patient level data collected from comprehensive inpatient rehabilitation hospitals. The agency will continue to monitor national developments and evaluate the efficiency and value of supplementing the initial set of eleven primary condition codes with data related to the patient’s functional status, diagnosis and procedure codes or of refining or expanding the set of primary condition codes.

Specific Authority 408.15(8) FS. Law Implemented 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a)-(b), 408.061(2)-(3), 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.085 FS. History–New 3-31-94.