32.1-276.6 - Patient level data system continued; reporting requirements.
§ 32.1-276.6. Patient level data system continued; reporting requirements.
A. The Virginia Patient Level Data System is hereby continued, hereinafterreferred to as the "System." Its purpose shall be to establish andadminister an integrated system for collection and analysis of data whichshall be used by consumers, employers, providers, and purchasers of healthcare and by state government to continuously assess and improve the quality,appropriateness, and accessibility of health care in the Commonwealth and toenhance their ability to make effective health care decisions.
B. Every inpatient hospital shall submit to the Board patient level data asset forth in this subsection. Every general hospital, ordinary hospital,outpatient surgical hospital or other facility licensed or certified pursuantto Article 1 (§ 32.1-123 et seq.) of Chapter 5 of this title and everyphysician and every oral and maxillofacial surgeon certified to performcertain procedures pursuant to § 54.1-2709.1 performing surgical proceduresin his office shall also submit to the board outpatient surgical data as setforth in this subsection. Every oral and maxillofacial surgeon certified toperform certain procedures pursuant to § 54.1-2709 shall submit to the Boardoutpatient surgical data as set forth in this subsection for only thoseprocedures for which certification is required pursuant to § 54.1-2709.1.
Any such hospital, facility, physician or oral and maxillofacial surgeon, asdefined in § 32.1-276.3, may report the required data directly to thenonprofit organization cited in § 32.1-276.4. Unless otherwise noted, patientlevel data elements for hospital inpatients and patients having outpatientsurgery shall include, where applicable and included on standard claim forms:
1. Hospital identifier;
2. Attending physician identifier (inpatient only);
3. Operating physician or oral and maxillofacial surgeon identifier;
4. Payor identifier;
5. Employer identifier as required on standard claims forms;
6. Patient identifier (all submissions);
7. Patient sex, race (inpatient only), date of birth (including centuryindicator), street address, city or county, zip code, employment status code,status at discharge, and birth weight for infants (inpatient only);
8. Admission type, source (inpatient only), date and hour, and diagnosis;
9. Discharge date (inpatient only) and status;
10. Principal and secondary diagnoses;
11. External cause of injury;
12. Co-morbid conditions existing but not treated;
13. Procedures and procedure dates;
14. Revenue center codes, units, and charges as required on standard claimsforms; and
15. Total charges.
C. State agencies providing coverage for outpatient services shall submit tothe Board patient level data regarding paid outpatient claims. Information tobe submitted shall be extracted from standard claims forms and, whereavailable, shall include:
1. Provider identifier;
2. Patient identifier;
3. Physician or oral and maxillofacial surgeon identifier;
4. Dates of service and diagnostic, procedural, demographic, pharmaceutical,and financial information; and
5. Other related information.
The Board shall promulgate regulations specifying the format for submissionof such outpatient data. State agencies may submit this data directly to thenonprofit organization cited in § 32.1-276.4.
(1996, c. 902; 2001, c. 341; 2003, c. 466; 2009, c. 652.)