Section R9-11-502. Reporting Requirements

A.      A hospital administrator shall ensure that the following infor- mation, in a format specified by the Department, is submitted to the Department as part of the emergency department dis- charge report required in subsection (C):

1.        The name of the hospital;

2.        The hospital’s Arizona facility ID and national provider identifier;

3.        The name, mailing address, telephone number, and e-mail address of the individual at the hospital whom the Depart- ment may contact about the emergency department dis- charge report;

4.        If the entity submitting the emergency department dis- charge report to the Department is different from the hos- pital:

a.        The name of the entity submitting the emergency department discharge report to the Department; and

b.        The name, mailing address, telephone number, and e-mail address of the individual at the entity speci- fied in subsection (A)(4)(a) who prepared the emer- gency department discharge report;

5.        The reporting period; and

6.        The name of the electronic file containing the emergency department discharge report specified in subsection (C).

B.       A hospital administrator or designee shall on a form provided by the Department:

1.        Attest that, to the best of the knowledge and belief of the hospital administrator or designee, the information sub- mitted according to subsection (C) is accurate and com- plete; or

2.        If the hospital administrator or designee has personal knowledge that the information submitted according to subsection (C) is not accurate or not complete:

a.        Identify the information that is not accurate or not complete;

b.        Describe the circumstances that make the informa- tion not accurate or not complete;

c.        State what actions the hospital is taking to correct the inaccurate information or make the information complete; and

d.        Attest that, to the best of the knowledge and belief of the hospital administrator or designee, the informa- tion submitted according to subsection (C), except the information identified in subsection (B)(2)(a), is accurate and complete.

C.      A  hospital  administrator   shall  ensure   that  an  emergency department discharge report:

1.        Is prepared and named in a format specified by the Department;

2.        Uses codes and a coding format specified by the Depart- ment for data items specified in subsection (C)(3) that require codes; and

3.        Contains the following information for each emergency department discharge that occurred during the reporting period specified in subsection (A)(5):

a.        The Arizona facility ID and national provider identi- fier for the hospital;

b.        A code indicating that the information submitted about the patient is for an emergency department episode of care;

c.        The patient’s medical record number;

d.        The patient’s control number;

e.        The patient’s name;

f.         The patient’s mailing address;

g.        If the patient is not a resident of the United States, a code indicating the country in which the patient resides;

h.        A code indicating that the patient is homeless, if applicable;

i.         The patient’s date of birth and last four digits of the patient’s Social Security number;

j.         Codes indicating the patient’s gender, race, ethnicity, and marital status;

k.        The date and a code indicating the hour the episode of care began;

l.         A code indicating the priority of visit;

m.      A code indicating the referral source;

n.        The date and a code indicating the hour the patient was discharged from the emergency department;

o.        A code indicating the patient’s discharge status;

p.        Whether the patient has a DNR known to the hospi- tal;

q.        The date the patient’s bill was created;

r.         The total charges billed for the episode of care;

s.        A code indicating the expected payer source;

t.         For each unit of service billed for the episode of care, the:

i.         Revenue code;

ii.        Charge billed; and

iii.      HCPCS code, if applicable;

u.        The code designating the version of the set of Inter- national Classification of Diseases codes used to prepare the bill for the episode of care;

v.        The International Classification of Diseases code designating the reason for the patient initiating the episode of care;

w.      The International Classification of Diseases codes for the patient’s principal and, if applicable, second- ary diagnoses;

x.        If applicable, the E-codes associated with the epi- sode of care;

y.        If applicable, the state in which an accident leading to the episode of care occurred;

z.        If applicable, the date of the onset of symptoms leading to the episode of care;

aa. For each procedure performed during the episode of care:

i.         The applicable International Classification of Diseases, HCPCS/CPT codes for the principal procedure and any other procedures performed during the episode of care; and

ii.        The dates the principal procedure and any other procedures were performed;

bb. The name, state license number, and, if applicable, national provider identifier of the patient’s attending provider;

cc. The code for the state licensing board that issued the license for the patient’s attending provider;

dd. The name, state license number, and, if applicable, national provider identifier of the medical practi- tioner who performed the patient’s principal proce- dure, if applicable;

ee. The code for the state licensing board that issued the license for the medical practitioner who performed the patient’s principal procedure, if applicable;

ff. The name, state license number, and, if applicable, national provider identifier of any other medical practitioner associated with the patient’s episode of care; and

gg. The code for the state licensing board that issued the license for each of the individuals specified in sub- section (C)(3)(ff).

D.      A hospital administrator shall ensure that the report specified in subsection (C), the information specified in subsection (A), and the attestation statement specified in subsection (B) are submitted to the Department twice each calendar year, accord- ing to the following schedule:

1.        For each emergency department discharge between Janu- ary 1 and June 30, the report, information, and attestation statement shall be submitted after June 30 and no later than August 15; and

2.        For each emergency department discharge between July 1 and December 31, the report, information, and attestation statement shall be submitted after December 31 and no later than February 15.

E.       A hospital administrator who receives a request from the Department for revision of an emergency department dis- charge report not prepared according to subsections (A), (B), and (C) shall ensure that the revised report is submitted to the Department:

1.        Within 21 calendar days after the date on the Depart- ment’s letter requesting an initial revision, and

2.        Within seven calendar days after the date on the Depart- ment’s letter requesting a second revision.

F.       If a hospital administrator or designee does not submit the report specified in subsection (C), the information specified in subsection (A), and the attestation statement specified in sub- section (B) according to this Section, the Department may assess civil penalties as specified in A.R.S. § 36-126.

Historical Note

Section recodified from R9-11-402 at 10 A.A.R. 3835, effective August 24, 2004 (Supp. 04-3). Amended by final rulemaking at 13 A.A.R. 3648, effective December 1, 2007 (Supp. 07-4).