Illinois Administrative Code › Title 77 - PUBLIC HEALTH › Part 1010 - HEALTH CARE DATA COLLECTION AND SUBMISSION CODE › Section 1010.50 - Common Data Verification, Review, and Comment Procedures

Current through Register Vol. 48, No. 28, July 12, 2024
a) Each facility shall review its patient
			 discharge data for accuracy and completeness before submitting the data
			 specified in this Part to the Department.
b) The Department will edit each data
			 submission for proper file formatting; content and context edits will be
			 applied to each data element as appropriate; the file will be checked for
			 duplicate records; and the database transactions will result in a data
			 submission profile that will be available in electronic format on the
			 Department's data submission web site.
c) The submitting facility shall obtain and
			 review the data submission profile as specified in subsection (b) of this
			 Section from each data submission to verify that data received and accepted by
			 the Department are in fact a complete and accurate representation of the
			 services provided by the facility during the stated time frames. If a facility
			 or the Department determines that any data are in fact incomplete or
			 inaccurate, it is the facility's responsibility to submit corrected data prior
			 to the final closing date of the affected data collection period.
d) If the Department determines that data
			 submitted by a facility are questionable, inaccurate or incomplete during or
			 after the close of a quarterly submission period, the Department shall conduct
			 an on-site review of the facility's data submission practices. Upon
			 notification of the need for such a review by the Department, any hospital or
			 ambulatory surgical treatment center affected shall, within 2 calendar weeks or
			 10 working days, whichever is the longer, gather information related to the
			 review process. The facility shall provide suitable workspace and access to all
			 required information from the medical records and patient claims and encounter
			 data underlying and documenting the inpatient or outpatient data under review.
			 Facilities shall provide access to other related documentation deemed necessary
			 to conduct a successful desk audit of inpatient and outpatient data submitted.
			 The on-site review shall be carried out by Department staff over a minimum of
			 one working day and extend for no more than three working days. The facility
			 under review shall ensure the availability of persons knowledgeable of the
			 internal organizational processes and information processing systems with the
			 ability to identify inaccurate and unreasonable data characteristics based on
			 the patient mix and services provided by the facility. Facility staff shall
			 produce a summary document within 30 days identifying the findings of the
			 on-site review and detailing the corrective action necessary to correct the
			 deficiencies discovered. The facility shall closely monitor future data
			 submissions to ensure that submissions accurately reflect actual patient mix
			 and health care services provided. It is the responsibility of each facility to
			 review the results of each data submission for erroneous, inaccurate,
			 incomplete or unreasonable information in data accepted by the Department and
			 to resubmit accurate data prior to the end of the submission period.
e) Final edited data shall be received prior
			 to the final closing date, 20 calendar days after the start date for internal
			 data review as specified in Section
			 1010.40(a)(1)
			 of this Part. Five calendar days are specified between the initial and final
			 closing dates to correct errors in claims and encounter data that were rejected
			 on the last day of submission. There shall be no correction period for
			 erroneous data received during this five-day period. To meet these
			 requirements, the facility shall do all of the following:
1) Correct and re-submit all data rejected
			 throughout the quarterly submission period because of errors revealed by the
			 Department edit checks performed under subsection (b) of this Section, and
			 submit any missing claims and encounter data;
2) Review the resultant data profile for
			 accuracy and completeness; and
3)
			 Supply the Department with an affirmation statement, signed by the chief
			 executive officer or designee, indicating that the facility's data are accurate
			 and complete.