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RULE §421.6Acceptance of Discharge Reports and Correction of Errors

(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.

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

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