| (a) Within 5 months after the end of each reporting
quarter, DSHS shall establish a process to compile one or more electronic
data files for each facility using the event claims received from
each facility. The certification file shall have one record for each
patient event during the reporting quarter and one record for any
patient event occurring during one prior reporting quarter for which
additional event claims have been received. The data files, including
reports returned to the facilities, allow the facility to provide
physicians and other health professionals the opportunity to review,
request correction of, and comment on patients for whom an event occurred
under the jurisdiction of the facilities and they are indicated as
"attending" or "operating or other." DSHS shall determine the format
and medium in which the quarterly file will be delivered to facilities.
(b) The chief executive officer or chief executive
officer's designated agent of each facility shall mark the appropriate
box on the form provided indicating whether the facility is certifying
or not certifying the event data and reports in the certification
file specified in subsection (a) of this section. The chief executive
officer or chief executive officer's designated agent shall sign and
return the form to DSHS by fax or mail. A person designated by the
chief executive officer and acting as the officer's agent may sign
the certification form. Designation of an agent does not relieve the
chief executive officer of personal responsibility for the certification.
If the chief executive officer or chief executive officer's designated
agent does not believe the quarterly file is accurate, the officer
shall provide DSHS with detailed comments regarding the errors or
submit a written request (on a form supplied by DSHS) and provide
the data, processes and resources necessary to correct any inaccuracy
and certify the certification file subject to those corrections being
made prior to the deadlines specified in this subsection. Corrections
to certification event data shall be submitted on or prior to the
following schedule: Quarter 1- October 1; Quarter 2- January 1; Quarter
3- April 1; and Quarter 4- July 1. Chief Executive Officers or designees
that elect not to certify shall submit a reasoned justification explaining
their decision to not certify their discharge encounter data and attach
the justification to the certification form. Election to not certify
data does not prevent certification file data from appearing in the
public use data file. Data that is not corrected and submitted by
the deadline may appear in the public use data file.
(c) The signed certification form shall represent that:
(1) policies and procedures are in place within the
facility's processes to validate and assure the accuracy of the event
data and any corrections submitted; and
(2) all errors and omissions known to the facility
have been corrected or the facility has submitted comments describing
the errors and the reasons why they could not be corrected; and
(3) to the best of their knowledge and belief, the
data submitted accurately represents the facility's administrative
status of patients for which the services covered by the revenue codes
or surgical and radiological categories identified in §421.67(f)
or §421.67(g) of this title (relating to Event File--Records,
Data Fields and Codes) were provided for the reporting quarter; and
(4) the facility has provided physicians and other
health professionals a reasonable opportunity to review and comment
on the event data of patients for which they were reported in one
of the available physician number and name fields provided on the
acceptable formats specified in §421.67 of this title (for example,
"attending physician" or "operating or other physician" as applicable).
The physicians or other health professionals may write comments and
have errors brought to the attention of the chief executive officer
or the chief executive officer's designated agent who shall address
any comments by the physicians or other health professionals; or
(5) if the chief executive officer or the officer's
designee elects not to certify the event data file for a specific
quarter, a written justification of any unresolved data issues concerning
the accuracy and completeness of the data at the time of the certification
shall be included on the certification form. Event claim data that
has been audited, returned to the facility and is not certified, may
be released and published in the public use data file and used by
DSHS for analysis.
(d) Each facility shall submit its certification form
for each quarter's data to DSHS by the fifteenth day of the seventh
month (Quarter 1- October 15; Quarter 2- January 15; Quarter 3- April
15; and Quarter 4- July 15) following the last day of the reporting
quarter as specified in §421.63(a)(1) - (4) of this title (relating
to Schedule for Filing Event Files). DSHS may extend the deadline
for any or all facilities when deemed necessary.
(e) Facilities, physicians or other health professionals
may submit concise written comments regarding any data submitted by
the associated facilities or relating to services they have delivered
which may be released as public use data. Comments shall be submitted
to DSHS on or before the dates specified in subsection (d) of this
section, regarding the submission of the certification form. Commenters
are responsible for assuring that the comments contain no patient
or physician identifying information. Comments shall be submitted
electronically using the method described in §421.64(a) and (b)
of this title (relating to Instructions for Filing Event Files).
(f) Failure to submit a signed certification form that
is supplied by DSHS on or before the dates specified in subsection
(d) of this section corresponding to event data previously submitted
shall be considered as not certified.
|
| Source Note: The provisions of this §421.66 adopted to be effective August 29, 2004, 29 TexReg 8123; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8842; amended to be effective February 26, 2009, 33 TexReg 9694; amended to be effective October 31, 2011, 36 TexReg 5214; amended to be effective July 5, 2017, 42 TexReg 3373 |
