Medical Information Reporting for California (MIRCal)

Medical Information Reporting for California (MIRCal)

Success Along the MIRCal Path

Success Along the MIRCal Path

Candace L. Diamondcdiamond@oshpd.ca.gov

CASA Annual Conference 2005

AgendaAgenda

• Program Status

• Frequently Asked Questions

• Data Findings

• Future Enhancements

Voluntary Data Submissions

Voluntary Data Submissions

• Limited Timeframe: Feb 16 - Mar 29, 2005• Data from Oct-Dec 2004

a) 94 Emergency Departments

b) 94 Hospital-based Ambulatory Surgery Clinics

c) 34 Freestanding Ambulatory Surgery Centers

• Win-Win!a) Facilities tested format & mapping w/o pressure

b) Personal attention & training from PDS analysts

c) Freestanding ASCs learned the MIRCal process

d) We were able to do more testing with ‘live’ data

Thank you!

Now It’s Real & It’s WorkingNow It’s Real & It’s Working

• Emergency Departments (ED)a) 340 approved reports

b) 6 unreceivable reports

• Hospital-based Ambulatory Surgerya) 370 approved reports

b) 62 unreceivable reports

• Freestanding Ambulatory Surgery Centersa) 439 approved reports

b) 14 unreceivable reports

Report Periods & Due DatesReport Periods & Due Dates

• 1st Quarter: January – Marchdue May 15th

• 2nd Quarter: April – Junedue August 14th

• 3rd Quarter: July – Septemberdue November 14th

• 4th Quarter: October – Decemberdue February 14th

CongratulationsCongratulations

• 809 ambulatory surgery facilities reported a total of 692,126 records

• Sutter North Procedure Center was the first freestanding licensed ambulatory surgery center to receive “Approved” status for their report on April 13th.

Data ExceptionsData Exceptions

• Modification key is timing

• Non-compliance key is the plan to correct

• Variant Action key is valid data

Fees & PenaltiesFees & PenaltiesRequired by law

• July 2005 fee collection based on ASC estimate• Assessed at 50 cents per record

Penalties for late or non-compliant reports = $100 per day

• Penalty assessment begins with 3rd Quarter 2005• Appeal process• Test (early & often) vs. Formal Submission• Analysts provide assistance• Extension days available (14 days)

FAQ # 1FAQ # 1• What type of facilities are required

to report AS data to MIRCal?

a) Freestanding Ambulatory Surgery

Centers (Certified)

b) Freestanding Ambulatory Surgery

Centers (Licensed as surgical clinic)

c) Hospitals

d) Both b and c

ASC Data Reporting to OSHPD

Licensed Surgical Clinics

Medi-Cal Certified ASCs

Medicare Certified ASCs

Other ASC Ownerships

Key DefinitionsKey DefinitionsRecord: An ambulatory surgery data record shall be

submitted for each encounter during the quarterly

reporting period in which at least one ambulatory

surgery procedure was performed

Procedure:

• Surgical in nature

• Carries a procedural risk

• Carries an anesthetic risk

• Coded using CPT- 4 (no modifiers)

FAQ # 2FAQ # 2

• What procedure codes will OSHPD collect?

a) CPT Codes 10000-69999

b)CPT Codes 10000-69999, HCPCS G Codes

c) CPT Codes 00100-99999

d)CPT Codes 00100-99999, 0001T-9999T

FAQ # 3FAQ # 3

• Can OSHPD crosswalk the HCPCS Level II G codes to HCPCS Level I CPT codes?

a) Yes

b)No

FAQ # 4FAQ # 4

• Can we report modifiers with CPT codes?

a) Yes

b) No

FAQ # 5FAQ # 5

• Do we report cancelled procedures?

a) Yes, if the procedure was begun

b) No

c) Report every procedure whether it was begun or not.

E CodesE Codes

External Cause of Injury Codes (E-Codes)• Must be reported for the discharge or encounter

during which the injury, poisoning and/or adverse

effect was first diagnosed or treated

• E-Codes are assigned from the International

Classification of Diseases, 9th Revision, Clinical

Modification (ICD-9-CM) (E800 – E999)

• Reporting medical/surgical misadventures and

abnormal reaction codes (E870 – E879) is optional

FAQ # 6FAQ # 6• For an injury that was first diagnosed

or treated, where is E code reported?

a) First inpatient discharge

b) First ED encounter

c) First AS encounter

d) First physician office

e) Only a, b, or c, whichever occurs first

FAQ # 7FAQ # 7

• If an injured patient was first diagnosed in a doctor’s office and sent to Endoscopy ASC, who reports the E code?

a) Doctor’s office

b) Endoscopy ASC

c) Not applicable

FAQ # 8FAQ # 8• There is a staff change to accessing

MIRCal system. What do I do?

a) Permit other staff to access MIRCal for you.

b)Wait to be contacted by MIRCal before updating the changes

c) Contact the UAA to update the MIRCal system (User Access)

d) All of the above

FAQ # 9FAQ # 9

• Where can I find licensing information?

a) www.oshpd.ca.gov/ALIRTS/index.htm

b)www.oshpd.ca.gov/hid/MIRCal/index/htm

Current Edits Current Edits

• Blank and Invalid values• Age greater than 120 years• Date of Birth after Service Date• Service Date outside report period• HIV test result reported• Duplicate diagnosis code• Place of occurrence E-code missing

Future Edits?Future Edits?

• Illogical relationships between data elements (sex, dates, diagnoses, procedures)

• Illogical relationships between codes in a data element (all Medicare Part A?)

Jan-Mar 2005First Statewide Data for CAJan-Mar 2005First Statewide Data for CA

• Number of Patient Recordsa) ED 2,137,740

b) Hospital AS 253,712

c) Freestanding ASCs 437,542

• Average Number of Extension Days Useda) ED 9 days

b) Hospital AS 7 days

c) Freestanding ASCs 7 days

Jan-Mar 2005GenderJan-Mar 2005Gender

Hospital AS• 244,353 Females• 192,246 Males• 2,785 Unknown• 0 Invalid and Blank

Freestanding ASCs• 138,659 Females• 108,639 Males• 1,831 Unknown• 3 Invalid and Blank

Jan-Mar 2005RaceJan-Mar 2005Race

Hospital AS• Highest: 311,895 White (code R5)• Lowest: 2,726 Amer.Indian/Alaskan (code R1)• Problem: 24,834 Unknown Race (code 99)

Freestanding ASCs• Highest: 122, 608 White (code R5)• Lowest: 809 Hawaiian/Pac.Islander (code R4)• Problem: 77,155 Unknown Race

(code 99)

Jan-Mar 2005EthnicityJan-Mar 2005EthnicityHospital AS

• 87,650 Hispanic or Latino (code E1)• 323,443 Non-Hispanic or Non-Latino (code

E2)• 28,275 Unknown Ethnicity (code 99)

Freestanding ASCs• 30,427 Hispanic or Latino (code E1)• 122,866 Non-Hispanic or Non-Latino (code E2)• 95,822 Unknown Ethnicity (code 99)

Jan-Mar 2005 Top 3 DiagnosesJan-Mar 2005 Top 3 Diagnoses

Hospital AS1. V76.51 Special Screening, Colon (15,645)

2. 211.3 Benign Neoplasm, Colon (11,771)

3. 366.9 Unspecified Cataract (10,511)

Freestanding ASCs1. 211.3 Benign Neoplasm, Colon (19,448)

2. 366.16 Senile Cataract, Nuclear (10,854)

3. 562.10 Diverticulosis, Colon, (9,389)

with no hemorrhage

Jan-Mar 2005Diagnoses (data quality)Jan-Mar 2005Diagnoses (data quality)

Hospital ASa) Valid - 739,116 Princ. Diagnoses

747,686 Other Diagnosesb) Blank - 241 Princ. Diagnosesc) Invalid - 27 Princ. Diagnoses

9 Other Diagnoses

Freestanding ASCsa) Valid - 248,914 Princ. Diagnoses

166,363 Other Diagnosesb) Blank - 44 Princ. Diagnosesc) Invalid - 174 Princ. Diagnoses

144 Other Diagnoses

Jan-Mar 2005 Top 3 ProceduresJan-Mar 2005 Top 3 Procedures

Hospital AS 1. 45378 Colonoscopy (27,756)

2. 66984 Cataract Extraction with intraocular

lens insertion (25,223)

3. 43239 EGD with biopsy (21,441)

Freestanding ASCs

1. 45378 Colonoscopy (31,912)

2. 66984 Cataract Extraction with intraocular

lens insertion (27,180)

3. 43239 EGD with biopsy (17,963)

Jan-Mar 2005Procedures (data quality)Jan-Mar 2005Procedures (data quality)

Hospital AS

a) Valid - 438,471 Princ. Procedures 453,975 Other Procedures

b) Invalid - 152 Princ. Procedures 531 Other Procedures

c) Blank - 761 Princ. Procedures

Freestanding ASCsa) Valid - 248,913 Princ. Procedures

67,151 Other Proceduresb) Invalid - 165 Princ. Procedures

50 Other Proceduresc) Blank - 54 Princ. Procedures

Jan-Mar 2005 Top 3 External Causes of InjuriesJan-Mar 2005 Top 3 External Causes of Injuries

Hospital AS

1. E928.9 Unspecified Accidents (2,263)

2. E927. Overexertion (1,336)

3. E888.9 Unspecified Falls (1,041)

Freestanding ASCs1. E928.9 Unspecified Accidents (825)

2. E927. Overexertion (528)

3. E929.9 Late effect of Unspecified Accidents (124)

Jan-Mar 2005 External Causes of Injury CodesJan-Mar 2005 External Causes of Injury Codes

Hospital AS a) Valid 19,425 Princ. E Codes

19,132 Other E Codes

b) Invalid - 3 Princ. E Codes

3 Other E Codes

Freestanding ASCs

a) Valid - 2,577 Princ. E Codes

2,416 Other E Codes

b) Invalid - 21 Princ. E Codes

9 Other E Codes

Jan-Mar 2005 Place of Occurrence - as cause

Jan-Mar 2005 Place of Occurrence - as cause

Hospital AS – Principal E Code Position

a) E849.0 Home 8b) E849.3 Industrial Places 1c) E849.4 Recreation Places 1d) E849.7 Residential Institution 14e) E849.9 Unspecified Place 16

Freestanding ASCs – Principal E Code Positiona) E849.0 Home 2b) E849.3 Industrial Places 8c) E849.4 Recreation Places 2d) E849.6 Public Building 1e) E849.7 Residential Institution 1f) E849.9 Unspecified Place 15

Jan-Mar 2005 Place of Occurrence - unspecifiedJan-Mar 2005 Place of Occurrence - unspecified

Hospital AS – Other E Codesa) E849.0 Home 3,942b) E849.3 Industrial Places 793c) E849.4 Recreation Places 1,472d) E849.7 Residential Institution 1,363e) E849.8 Other Specified Place 1,518f) E849.9 Unspecified Place 8,605

Freestanding ASCs – Other E Codesa) E849.0 Home 85b) E849.3 Industrial Places 938c) E849.4 Recreation Places 191d) E849.6 Public Building 184e) E849.7 Residential Institution 26f) E849.8 Other Specified Place 82g) E849.9 Unspecified Place 784

Jan-Mar 2005SSN data quality = very good!Jan-Mar 2005SSN data quality = very good!

Hospital AS• Valid - 412,499• Invalid - 257 • Unknown - 26,558• Blank - 70

Freestanding ASCs• Valid - 223,096• Invalid - 41• Unknown - 25,899• Blank - 96

Jan-Mar 2005 Top 3 DispositionsJan-Mar 2005 Top 3 Dispositions

Hospital AS1. 422,760 - Home (code 01)2. 13,758 - Other (code 00)3. 1,121 - Medicare-certified SNF (code 03)

Freestanding ASCs1. 240,231 - Home (code 01)2. 7,501 - Other (code 00)3. 585 - Blank/Missing (code - )

Other Findings: DeathsHospital AS 47Freestanding ASCs 0

Jan-Mar 2005 Top 4 PayersJan-Mar 2005 Top 4 Payers

Hospital AS1. 108,694 - HMO (code HM)

2. 56,242 - Medicare Part A (code MA)

3. 48,435 - PPO (code 12)

4. 43,019 - Medi-Cal (code MC)

Freestanding ASCs1. 60,406 - Medicare Part B (code MB)

2. 36,794 - Blue Cross/Blue Shield (code BL)

3. 32,727 - PPO (code 12)

4. 26,062 - HMO (code HM)

Jan-Mar 2005 Questioned PayersJan-Mar 2005 Questioned Payers

Hospital AS• 36,058 - Medicare Part B (code MB)• 13,584 - Other (code 00)

Freestanding ASCs • 11,759 - Medicare Part A (code MA)• 8,266 - Other (code 00)

Importance of Ambulatory Surgery Data

Importance of Ambulatory Surgery Data

• Legislative staff, health planners, researchers, state agencies, insurers, media, and health facilities

• Growth and trends of ambulatory surgery• Comparisons with hospital care• Needs assessments, marketing, outcomes,

report cards, access to healthcare, healthcare disparities

Data AvailabilityData Availability

• Immediate Data Distribution Report

• Summaries on the Internet 15 days after approval

• Public data sets with sensitive data masked

• Custom reports from OSHPD

• HIRC@oshpd.ca.gov

MIRCal ResourcesMIRCal Resources

• Monthly updates to MIRCal Informational

Web site

• “Quick Notes” publication

• Computer Based Training (CBT),

Updated for ED & AS – December 2004

• ED & AS Reporting Manual – June 2005

MIRCal Web and E-mailMIRCal Web and E-mail

• MIRCal Web Site (Bookmark it today!!)

http://www.oshpd.ca.gov/MIRCalWhat’s New, Presentations, FAQ, UAA Forms, CBT, Regulations, Quick Notes, Contact Information, etc.

• MIRCal E-mail: mircal@oshpd.ca.gov

Questions and

Answers

Questions and

Answers

Thank you , CASA