Claims Data Discharge Reports by Ambulatory Surgical Treatment Centers (Astcs) — Penalties — Waiver — Civil Liability — Exceptions
Checkout our iOS App for a better way to browser and research.
Each licensed ambulatory surgical treatment center (ASTC) and each licensed outpatient diagnostic center (ODC) shall report all claims data found on the appropriate form on every discharge to the commissioner of health. ASTCs and ODCs shall file joint annual reports as required by the department of health. ASTCs and ODCs shall submit the data through third party entities approved by the department of health for the purpose of editing the data according to rules and regulations established by the commissioner. The ASTCs and ODCs shall be responsible for the costs associated with processing of the data by the approved vendors. An ASTC and an ODC shall report the claims data at least quarterly to the commissioner. No information shall be made available to the public by the commissioner that reasonably could be expected to reveal the identity of any patient. The claims data reported to the commissioner under this section are confidential and not available to the public until the commissioner processes and verifies the data. The commissioner shall prescribe conditions under which the processed and verified data are available to the public and shall establish policies for the release of HIPAA compliant limited use data sets.
A licensed ASTC and ODC shall pay to the commissioner a civil penalty of five cents (5¢) for each day the claims data discharge report is delinquent. A claims data report is delinquent if the commissioner does not receive it before sixty (60) days after the end of the quarter. If the commissioner receives the report in incomplete form, the commissioner shall notify the ASTC and ODC and provide fifteen (15) additional days to correct the error. The notice shall provide the ASTC and ODC an additional fifteen (15) days to complete the form and return it to the commissioner prior to the imposition of any civil penalty. The maximum civil penalty for a delinquent report is ten dollars ($10.00) for each discharge record. The commissioner shall issue an assessment of the civil penalty to the ASTC and ODC. The ASTC and ODC has a right to an informal conference with the commissioner, if the ASTC and ODC requests the conference within thirty (30) days of receipt of the assessment. After the informal conference or, if no conference is requested, after the time for requesting the informal conference has expired, the commissioner may proceed to collect the penalty by setting the penalty off against funds owed to the ASTC and ODC or by instituting litigation.
In its request for an informal conference, the ASTC and ODC may request the commissioner to waive the penalty. The commissioner may waive the penalty in cases of an act of God or other acts beyond the control of the ASTC and ODC. Waiver of the penalty is in the sole discretion of the commissioner. None of these proceedings are subject to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
No person or entity may be held liable in any civil action with respect to any report or disclosure of information made under this section, unless the person or entity has knowledge of any falsity of the information reported or disclosed.
This section shall not affect or replace any other reporting responsibility placed upon ASTCs. The report filed pursuant to this section shall not be required for discharges reported by ASTCs under § 68-3-505.
The claims data required to be reported by this section shall be collected and reported only to the extent it is collected and reported in the normal billing process, unless other claims data is deemed by the commissioner to be essential to the development or use of the ASTC claims data reporting system, in which case the identified data that is outside the normal billing process must be collected and reported; provided, however, that other claims data that may be required to be collected and reported shall be consistent with data required to be collected and reported by other healthcare providers. Any data that is submitted to the commissioner pursuant to this section shall be made available to the public no more frequently and no sooner after the data is submitted than the data collected and reported by licensed hospitals pursuant to § 68-1-108.