36-125.05. Uniform patient reporting system; statistical and demographic reports; exemption

A. The department shall prescribe and implement a uniform patient reporting system for hospital inpatient and emergency department services. The requirements imposed for this reporting system shall be substantially the same as the uniform billing requirements prescribed by the United States department of health and human services pursuant to titles XVIII and XIX of the social security act, as amended (42 United States Code sections 1395 through 1395pp), whether or not the effective date for the federal billing system is after January 31, 1984.

B. The department shall require hospitals to report inpatient statistical data designed to promote cost containment as the department determines. These data shall be derivable from the data obtained under the uniform patient reporting system prescribed by subsection A and, for all inpatient services, shall include the following:

1. The number of confinements.

2. The average length of stay.

3. The average charge per day.

4. The average charge per confinement, which is the product of the average length of stay multiplied by the average charge per day.

5. The average charge per confinement for each attending physician.

C. Each of the categories of data specified in subsection B shall be further categorized by one or more of the following methods as the department determines:

1. Discharge diagnoses.

2. Groupings of related diagnoses.

3. Groupings of diagnoses that typically have similar lengths of confinement.

4. Any other similar categories that may be determined by the department.

D. The department shall require hospital emergency departments to report outpatient service statistical data designed to promote cost containment. The department shall adopt rules establishing the procedures for reporting. These data shall be derivable from the data obtained under the uniform patient reporting system prescribed in subsection A, and shall include the following:

1. Date of service.

2. Surgical procedures.

3. Related diagnosis.

4. Charges for services.

E. The department may require hospitals and emergency departments to report other clinical and demographic data regarding patient age, sex or insurance coverage for inpatient and emergency department services.

F. The state hospital is exempt from the reporting requirements imposed by subsections B, D and E.

G. The data from the period beginning January 1 and ending June 30 of each year shall be reported on or before August 15 of that year. The data from the period beginning July 1 and ending December 31 of each year shall be reported on or before February 15 of the following year.

H. All reports filed pursuant to this section are open to public inspection at the offices of the department. The department shall ensure that this public access to reports does not breach confidentiality of privileged medical information or privileged information on an individual's work performance or earnings.

I. If further investigation is considered necessary or desirable to verify the accuracy of information in reports submitted under this section, the department may further examine records and accounts related to the reporting requirements of this section. The department shall bear the cost incurred in connection with this examination unless the department finds that the records examined are significantly deficient or incorrect, in which case the department may charge the cost of the investigation to the facility examined.