| (a) To verify the accuracy of all discharge claims
prior to public release, DSHS shall establish procedures for the review
of all discharge reports to determine whether the report is acceptable,
as required by Health and Safety Code, §108.011.
(b) Upon receipt of a discharge report, DSHS shall
determine if it satisfies minimum criteria for processing. If it does
not, DSHS shall return the discharge report in the same submission
format and media that is approved for that provider and state the
deficiencies in writing within ten calendar days of receipt. The hospital
shall resubmit the report within ten calendar days of notification
by DSHS. A discharge report does not meet minimum standards for processing
under the following circumstances as shown in paragraphs (1) - (3)
of this subsection.
(1) The physical media and labeling do not conform
to the specifications in §421.4 of this title (relating to Instructions
for Filing Discharge Reports).
(2) The physical media are unreadable due to physical
damage.
(3) The file structure does not conform to the specifications
in §421.9 of this title (relating to Discharge Reports--Records,
Data Fields and Codes), unless the hospital has received a letter
from DSHS authorizing filing in another format.
(c) Correction of Errors.
(1) DSHS shall review all discharge reports accepted
for processing and will process all discharge claims against the editing
criteria established by this section and by DSHS. Within 10 calendar
days of receipt of an accepted discharge report, DSHS shall notify
the hospital in detail of all errors detected in the discharge report.
(2) Within 30 calendar days of receiving initial notice
of errors in a discharge report, the hospital shall correct all discharge
claims containing errors, add any discharge claims determined to be
missing from the initial discharge report and resubmit the corrected
and/or previously missing discharge claims. If the hospital disagrees
with any identified error, the hospital may indicate that the discharge
claim is as accurate as it can be or cannot be corrected. Each hospital
shall submit such modified and/or additional discharge claims as may
be required to allow the chief executive officer or the chief executive
officer's designated agent to certify the quarterly discharge report
as required by §421.7 of this title (relating to Certification
of Discharge Reports). Corrections to a discharge report shall be
submitted on approved media and formats as specified in §421.4
of this title and §421.9 of this title unless DSHS approves another
medium or format.
(3) Within ten calendar days of receiving corrections
to a discharge report from a hospital, DSHS shall notify the hospital
of any remaining errors. The hospital shall have ten calendar days
from receipt of this notice to correct the errors noted or indicate
why the data should be deemed acceptable and complete. This process
may be repeated until the data is substantially accurate and the hospital
is able to certify the discharge report as required by §421.7
of this title or the deadline for submitting corrections prior to
certification is reached. Corrected data is required to be submitted
on or before the following dates for the respective quarter's discharges;
Quarter 1 - August 1, Quarter 2 - November 1, Quarter 3 - February
1, Quarter 4 - May 1. No individual hospitals will be granted extensions
to the dates. DSHS may grant an extension to all hospitals when deemed
necessary.
(4) Discharge claims that have not been previously
submitted shall be submitted prior to the deadline for the following
quarter's data. Correction and certification of these previously missing
or additional discharge claims for the prior calendar quarter shall
be made according to the deadlines established for following quarter
in which the data that is scheduled to be processed as specified in §421.3(a)(1)
of this title (relating to the Schedule for Filing Discharge Reports),
paragraph (3) of this subsection (relating to the Acceptance of Discharge
Reports and Correction of Errors) and §421.7(b) and (d) of this
title. Corrections to discharge claims previously submitted or that
have a discharge date prior to calendar quarter immediately before
the calendar quarter being processed scheduled will not be processed.
(d) DSHS will document and DSHS will approve all acceptance
and editing criteria utilized in reviewing discharge reports. If acceptance
and editing criteria are incorporated into computer software, and
if the software is the property of DSHS, DSHS will make copies of
the portions of the software containing the criteria available on
paper, magnetic, or other portable data storage media. DSHS shall
make this information available to submitters without charge and to
others for the cost of reproduction.
(e) Failure to correct or comment on a discharge report
which has been filed but contains errors or omissions, known to the
hospital, within the due dates in §421.3 of this title is punishable
by a civil penalty pursuant to Health and Safety Code, §108.014.
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| Source Note: The provisions of this §421.6 adopted to be effective August 19, 1997, 22 TexReg 7490; amended to be effective December 29, 1997, 22 TexReg 12494; amended to be effective July 29, 2001, 26 TexReg 5408; amended to be effective April 21, 2002, 27 TexReg 3183; amended to be effective July 6, 2003, 28 TexReg 4915; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8842; amended to be effective December 27, 2007, 32 TexReg 9683; amended to be effective July 5, 2017, 42 TexReg 3373; amended to be effective January 30, 2019, 44 TexReg 429 |
