Ala. Admin. Code r. 420-12-1-.01

Current through Register Vol. 43, No. 1, October 31, 2024

Section 420-12-1-.01 - Definitions

(1) "Aggregate Data" is a set of multiple data records that are tabulated, combined, or otherwise summarized for the purpose of describing characteristics of a group of patient discharges. No individualized patient data is identifiable in Aggregate Data.

(2) "AlaHA" means the administrative offices and staff of the Alabama Hospital Association.

(3) "Advisory Council" refers to the Hospital Discharge Data Advisory Council established under Code of Ala. 1975, § 22-21-410.

(4) "Department" is the Alabama Department of Public Health.

(5) "Delinquent Discharge Data Report" includes

(a) any Discharge Data Report not received by the Department within sixty (60) calendar days after the end of the quarter for which the Discharge Data is required to be reported; and

(b) any Discharge Data Report that remains uncorrected or incomplete after fifteen (15) calendar days following notification by the Department of receipt of an incomplete Discharge Data Report.

(6) "Discharge" is defined as the formal release of a patient from a hospital in either an inpatient or outpatient situation.

(7) "Discharge Data" means data regarding a patient's discharge as an inpatient or outpatient from a hospital, as required on the UB-04 claim form, or any successor form, and on other forms that include services provided for covered inpatient and outpatient discharges.

(8) "Discharge Data Report" means a report to the Department of all Discharge Records for patients receiving inpatient or outpatient services at a particular hospital during the three (3) months immediately preceding the date of the Discharge Data, as described in this Chapter and the Hospital Discharge Data System Procedure Manual.

(9) "Discharge Record" means a record of an individual inpatient or outpatient discharge required to be reported under Code of Ala. 1975, § 22-21-410, et seq., this Chapter, and the Hospital Discharge Data System Procedure Manual.

(10) "Error" means Discharge Data or Discharge Data Reports that are incomplete or inconsistent with the specifications set forth in this Chapter or the Hospital Discharge Data System Procedure Manual.

(11) "HIPAA" means the Health Insurance Portability and Accountability Act, Pub. L. 104-191.

(12) "Hospital" means general acute care, critical access and specialized hospitals, as well as any freestanding emergency department that is separately licensed by the Department as a provider-based division of a hospital, as defined by rules of the Department and licensed pursuant to Article 2 of Chapter 21 of Title 22, Code of Ala. 1975, and that are located in this state.

(13) "Hospital Discharge Data Procedure Manual" means the procedure manual prepared and maintained by AlaHA that provides the data elements for each hospital Discharge Record to be included in the Discharge Data Report submitted to the Department, their descriptions and reporting formats, and any additional information required to be included in the Discharge Data Report.

(14) "Inpatient Discharge" includes persons who received reception and care in a hospital for a continuous period of twenty-four (24) hours or more for the purpose of giving advice, diagnosis, nursing service, or treatment bearing on the physical health of the person, including persons receiving maternity care involving labor and delivery for any period of time.

(15) "Outpatient Discharge" includes persons receiving reception and care in a hospital for a continuous period of less than twenty-four (24) hours for the purpose of giving advice, diagnosis, nursing service, or treatment bearing on the physical health of the person, excluding persons receiving maternity care involving labor and delivery. Emergency Room Discharges are included in Outpatient Discharges for purposes of these rules.

(16) "Patient Identifiers" is defined as information that reasonably could be expected to reveal the identity of a patient, including those items contained in 45 C.F.R. § 164.514(b)(2)(i).

(17) "Processed Data" is defined as data that has been reviewed by the Department for the purpose of detecting errors, inconsistencies, and/or incomplete elements in the data set.

(18) "UB-04" is CMS Form 1450, the Uniform Hospital Billing Form, or a successor form as established by the National Uniform Billing Committee.

(19) "Verified Data" is defined as data that has been processed by the Department, reviewed and corrected by the hospital, and accepted by the Department.

Ala. Admin. Code r. 420-12-1-.01

Adopted by Alabama Administrative Monthly Volume XL, Issue No. 04, January 31, 2022, eff. 3/17/2022.

Author: Sherri L. Davidson, Ph.D., M.P.H.; Dana H. Billingsley

Statutory Authority:Code of Ala. 1975, § 22-21-410, et seq.