Kentucky Administrative Regulations › Title 900 - CABINET FOR HEALTH AND FAMILY SERVICES › Chapter 7 - Data Reporting and Public Use Data Sets › Section 900 KAR 7:030 - Data reporting by health care providers

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO: KRS Chapter 13B, 216.2920, 216.2925, 216.2927,
				304.14-135
NECESSITY, FUNCTION, AND CONFORMITY:
				KRS
				216.2925 requires that the Cabinet for Health
				and Family Services promulgate administrative regulations requiring specified
				health care providers to provide the cabinet with data on cost, quality, and
				outcomes of health care services provided in the commonwealth.
				KRS
				216.2923(3) authorizes the
				cabinet to promulgate administrative regulations to impose fines for failure to
				report required data. This administrative regulation establishes the required
				data elements, forms, and timetables for submission of data to the cabinet and
				fines for noncompliance.
Section 1.
			 Definitions.
(1) "Ambulatory facility" is
			 defined by
			 KRS
			 216.2920(1).
(2) "Cabinet" is defined by
			 KRS
			 216.2920(2).
(3) "Coding and transmission specifications",
			 "Kentucky Inpatient and Outpatient Data Coordinator's Manual for Hospitals", or
			 "Kentucky Data Coordinator's Manual for Ambulatory Facilities" means the
			 document containing the technical directives the cabinet issues concerning
			 technical matters subject to frequent change, including codes and data for
			 uniform provider entry into particular character positions and fields of the
			 standard billing form and uniform provider formatting of fields and character
			 positions for purposes of electronic data transmissions.
(4) "Hospital" is defined by
			 KRS
			 216.2920(6).
(5) "Hospitalization" means the inpatient
			 medical episode identified by a patient's admission date, length of stay, and
			 discharge date, that is identified by a provider-assigned patient control
			 number unique to that inpatient episode, except for hospice care.
(6) "National Provider Identifier" or "NPI"
			 means the unique identifier assigned by the Centers for Medicare and Medicaid
			 Services to an individual or entity that provides health care services and
			 supplies.
(7) "Outpatient services"
			 means services performed on an outpatient basis in a hospital in accordance
			 with Section 3(2) of this administrative regulation or services performed on an
			 outpatient basis by an ambulatory facility in accordance with Section 4 of this
			 administrative regulation.
(8)
			 "Provider" means a hospital, ambulatory facility, clinic, or other entity of
			 any nature providing hospitalizations, mammograms, or outpatient services as
			 defined in the Kentucky In-patient and Outpatient Data Coordinator's Manual for
			 Hospitals or the Kentucky Data Coordinator's Manual for Ambulatory
			 Facilities.
(9) "Record" means the
			 documentation of a hospitalization or outpatient service in the format
			 prescribed by the Kentucky Inpatient and Outpatient Data Coordinator's Manual
			 for Hospitals or the Kentucky Data Coordinator's Manual for Ambulatory
			 Facilities as approved by the Statewide Data Advisory Committee on a computer
			 readable electronic medium.
(10)
			 "Standard Billing Form" means the uniform health insurance claim form pursuant
			 to
			 KRS
			 304.14-135, the Professional 837 (ASC X12N
			 837) format, the Institutional 837 (ASC X12N 837) format, or its successor as
			 adopted by the Centers for Medicare and Medicaid Services, or the HCFA 1500 for
			 use by hospitals and other providers in billing for hospitalizations and
			 outpatient services.