Definitions, Ambulatory and Emergency Department Data Reporting and Audit Procedures, Reporting Instructions, Certification, Audits, and Resubmission Procedures, Penalties for Ambulatory Patient Data Reporting and Deficiencies, Ambulatory Data ...

AGENCY FOR HEALTH CARE ADMINISTRATION
Cost Management and Control

RULE NO: RULE TITLE
59B-9.031: Definitions
59B-9.032: Ambulatory and Emergency Department Data Reporting and Audit Procedures
59B-9.034: Reporting Instructions
59B-9.035: Certification, Audits, and Resubmission Procedures
59B-9.036: Penalties for Ambulatory Patient Data Reporting and Deficiencies
59B-9.038: Ambulatory Data Elements, Codes and Standards
59B-9.039: Public Records

NOTICE OF CHANGE

Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 35 No. 12, March 27, 2009 issue of the Florida Administrative Weekly.

59B-9.031 Definitions.

(5) “Emergency Department” means any department of any general hospital when a request is made for emergency services and care for any emergency medical condition which is within the service capability of the hospital as specified in Section 395.1041, F.S.

(5) through (7) renumbered (6) through (8) No change.

(8) “NUBC” means National Uniform Billing Committee. A national body that defines the data elements that are reported on the Uniform Bill UB-04 and annually publishes an Official UB-04 Data Specifications Manual.

(9) “NUCC” means the National Uniform Claims Committee. A national body that define the data fields that are reported on the HCFA 1500 which is published annually.

(10) through (13) renumbered (9) through (12) No change.

59B-9.032 Ambulatory and Emergency Department Data Reporting and Audit Procedures.

(4) Any Ambulatory Surgical Center receiving which has a total of 200 or more patient visits during the reporting quarter periods outlined in per Rule 59B-9.033, F.A.C., are for the reporting period is required to report data as specified set forth in Rules 59B-9.037 and 59B-9.038, F.A.C.

(5) Ambulatory Surgical Centers (ASC) receiving with fewer than 200 patient visits during the reporting quarter periods outlined in Rule 59B-9.033, F.A.C in a quarter, may request an exemption from a quarters reporting requirement. To request an exemption, the ASC shall send a letter on facility letterhead stating the number of patient visits for the reporting quarter and signed by the entity’s chief executive officer or director. The exemption letter shall be received at the Agency office in Tallahassee on or prior to the deadline for submission of the quarterly report must have the entity’s chief executive officer or director to certify to the Agency in writing, that the ambulatory center has fewer than 200 patient visits per Rule 59B-9.033, F.A.C., for the reporting period, and the certification is to be received at the Agency office in Tallahassee on or prior to the deadline for submission of the report. This is not a onetime letter, but must be submitted for each quarter where there were fewer than 200 visits.

59B-9.034 Reporting Instructions.

(5) Beginning with the Ambulatory data report for the 1st quarter of the year 2010, reporting facilities must submit a zipped outpatient XML file 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.

59B-9.035 Certification, Audits, and Resubmission Procedures.

(1) All ambulatory centers submitting data in compliance with Rules 59B-9.030 through 59B-9.039, F.A.C., shall certify that the data submitted for each quarter period is accurate, complete and verifiable using Certification Form for Ambulatory Patient Data AHCA Form APD1, dated 7/1/95, revised 09/01/2000 and incorporated by reference. The Agency will send a final certification packet to to the reporting entity containing their summary reports generated by the Agency, the Certification of Ambulatory Patient Data certification form and Agency contact information and instructions. The facility must complete and sign the certification form thereby “certifying” that they have examined the ambulatory patient data report and, to the best of their knowledge and belief, the information contained in this report is true, accurate, and complete, and has been prepared from the books and records of this ambulatory center, except as noted. The completed certification form must be either mailed shall be submitted to the Agency for Health Care Administration, 2727 Mahan Drive, MS #16, Tallahassee, Florida 32308. Attention: Florida Center for Health Information and Policy Analysis; or by facsimile to the Agency’s office; or a scanned certification submitted by electronic mail by the certification due date. Upon receipt of a facilities signed certification form by the Agency, the facility is considered “certified” for the reporting quarter.

(2) Beginning with the ambulatory data reporting for the 1st quarter of the year 2010, facilities not certified within five (5) calendar months following the last day of the reporting quarter shall be subject to penalties pursuant to Rule 59B-9.036, F.A.C. Extensions to this five (5) month period will may be granted by the Agency Administrator, Office of Data Collection and Quality Assurance Unit or the Agency designee, for a maximum of 30 days following the certification due date in response to a written request signed by the facilities chief executive officer, ambulatory center director or authorized executive officer designee.

(3) Changes or corrections to certified data will be accepted from facilities to improve their data quality for a period of eighteen (18) months following the initial submission due date. The Administrator, Office of Data Collection and Quality Assurance or designee will may grant approval for resubmitting previously certified data in response to a written request signed by the facility’s chief executive officer, Ambulatory Center director or authorized executive officer designee.

59B-9.036 Penalties for Ambulatory Patient Data Reporting and Deficiencies.

(5) Any ambulatory center which is delinquent for a reporting deficiency other than submission of a false report 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 $1,000 per day of violation for the third or subsequent violations to be fixed, imposed, and collected by the Agency. Any ambulatory center which files a false report with the Agency or provides false information to the Agency shall be subject to a fine not to exceed a of $1,000 per day per violation. to be fixed, imposed and collected by the Agency. 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 ambulatory center which files a false report with the Agency or provides false information to the Agency shall be subject to a fine not exceeding of $1000 per day per violation, in addition to any other fine imposed hereunder, pursuant to Section 408.813, 408.08 F.S. The fine shall be fixed, imposed and collected by the Agency.

59B-9.038 Ambulatory Data Elements, Codes and Standards.

Beginning with the ambulatory data reporting for the 1st quarter of the year 2010, all data elements and data element codes listed below shall be reported. All facilities submitting data in compliance with Rules 59B-9.030 through 59B-9.039, F.A.C., shall report the following required data elements as as stipulated by the Agency and described in the Official Data Specifications Manual published by the NUBC and NUCC.

59B-9.039 Public Records.

(4) Requests shall be submitted by users sufficiently in advance to permit the staff to respond without disruption of its duties as provided in Section 119.07(1)(c) (b), F.S.