DEFINITIONS

Carrier: refers to the numbers coded on a bill to delineate the primary and other insurer that identifies a private insurer, HMO, PPOs, etc..

Data Element: refers to any specific characteristic, usually encoded, describing a patient, services provided to a patient or the health care facility and/or professional providing the services, during a medical encounter.

Data Oversight Council: is as defined in Section 44-6-170, as amended, Code of Laws of South Carolina, 1976.

Disclosure: means to communicate, transmit, or in any way to convey any data, referred to in these regulations to any individual organization in any form, either written, verbal or otherwise.

Encounter Level Data: refers to data gathered or organized by each contact between a patient and a health care professional in which care was given.

Follow-back Investigation: refers to a procedure in which a researcher obtains additional data by contacting patients, next-of-kin, informants, physicians, hospitals and/or other individuals or facilities associated with the individual.

Health Care Facility: includes but is not limited to acute care hospitals, psychiatric hospitals, alcohol and substance abuse hospitals, tuberculosis hospitals, nursing homes, kidney disease treatment centers, including freestanding hemodialysis centers, ambulatory surgical facilities, rehabilitation facilities, residential treatment facilities for children and adolescents, habitation centers for mentally retarded persons or persons with related conditions and any other freestanding facility offering services or special equipment for which Certificate of Need review is required by state law. For the purposes of this document, Home Health Agencies are included as defined by "Licensure of Home Health Agencies Act," as a public, nonprofit or proprietary organization, whether owned or operated by one or more persons or legal entities, which furnishes or offers to furnish home health services.

Health Care Professional: includes but is not limited to physician, physician's assistant, dentist, dental hygienist, dental technician, pharmacist, physical therapist, physical therapists assistant, optometrist, psychologist, respiratory care practitioner, registered nurse, licensed practical nurse, podiatrist, occupational therapist or other health care professional registered or licensed and practicing in South Carolina.

Health Data Analysis Task Force: is as defined in Section 44-6-170, as amended, Code of Laws of South Carolina, 1976.

Identifiable Health Data: means any item, collection, or grouping of health data that makes the individual or entity described in the health data identifiable.

Insurer: refers to the names of the insurance companies, HMOs, PPOs, etc. that identify these organizations and are used to delineate the primary and other payers on a bill.

Research: means a systematic investigation, including research development, testing and evaluation, designed to develop or contribute to generalizable knowledge. [45 CFR 46.102(d)] Note: This is the same definition used and codified in HIPAA Regulations.

APPENDICES

Appendix A: Hospital Inpatient

Data Elements Required to Be Reported to RFA

  1. Patient social security number
  2. Health Insurance Number 1
  3. Health Insurance Number 2
  4. Health Insurance Number 3
  5. Patient name
  6. Patient address including city, state
  7. Patient zip code
  8. Medical record number
  9. Patient number
  10. Hospital federal tax identification number
  11. Patient Date of Birth
  12. Patient gender
  13. Patient race/ethnicity
  14. County of patient residence
  15. Admission date
  16. Discharge date
  17. Admission Hour
  18. Discharge Hour
  19. Admission source
  20. Admission type
  21. Admitting Diagnosis
  22. Present on Admission Indicator for All Diagnoses
  23. Diagnosis codes (including coding methodology)
  24. Procedure codes (including coding methodology)
  25. Procedure dates
  26. Primary E-codes
  27. Total charges
  28. Components of charges by revenue codes, including associated units for room and board
  29. Patient discharge status
  30. Principal source of payment
  31. Secondary source of payment
  32. Tertiary source of payment
  33. Physician NPI, SC State Licensure Number or Social Security Number for attending and up to two other physicians

 

Appendix B: Emergency Department and Facilities Reporting Observation Services

Data Elements Required to Be Reported to RFA

  1. Patient social security number
  2. Health Insurance Number 1
  3. Health Insurance Number 2
  4. Health Insurance Number 3
  5. Patient name
  6. Patient address including city, state
  7. Patient zip code
  8. Medical record number
  9. Patient number
  10. Hospital federal tax identification number
  11. Patient Date of Birth
  12. Patient gender
  13. Patient race/ethnicity
  14. County of patient residence
  15. Admission date
  16. Hour of Admission
  17. Hour of Discharge
  18. Discharge date
  19. Admission source
  20. Admission type
  21. Diagnosis codes (including coding methodology)
  22. Procedure codes (including coding methodology)
  23. Procedure dates
  24. Primary E-codes (exclude E870-E876)
  25. Total charges
  26. Components of charges by revenue codes, including associated units for room and board
  27. Patient discharge status
  28. Principal source of payment
  29. Secondary source of payment
  30. Tertiary source of payment
  31. Physician NPI, SC State Licensure Number or Social Security Number for attending and up to two other physicians

 

Appendix C: Ambulatory Surgery Facilities, Imaging and Services Requiring a Certificate of Need

Data Elements Required to Be Reported to RFA

  1. Patient social security number
  2. Health Insurance Number 1
  3. Health Insurance Number 2*
  4. Health Insurance Number 3*
  5. Patient name
  6. Patient address including city, state
  7. Patient zip code
  8. Medical record number**
  9. Patient number
  10. Health Care Facility/Provider Federal Tax Number
  11. Patient Date of Birth
  12. Patient gender
  13. Patient race/ethnicity
  14. County of patient residence
  15. Dates of Services
  16. Total Charges
  17. Principal Diagnosis Code (ICD-9-CM)
  18. Other Diagnosis Codes
  19. Procedure Coding System ICD-9-CM or CPT4
  20. Principal Procedure
  21. Other Procedures
  22. Principal source of payment
  23. Secondary source of payment***
  24. Tertiary source of payment***
  25. External Cause of Injury Code (excludes E870-E876)
  26. Physician NPI, SC State Licensure Number or Social Security Number for attending and up to two other physicians

*Free-standing Ambulatory Surgery Centers are required to report only one health insurance number.

**Free-standing Ambulatory Surgery Centers are not required to report Medical Record Numbers.

***Free-standing Ambulatory Surgery Centers are required to report only one source of payment.

 

Appendix D: Home Health Care Facilities

Data Elements Required to Be Reported to RFA

  1. Patient social security number
  2. Health Insurance Number 1
  3. Health Insurance Number 2*
  4. Health Insurance Number 3*
  5. Patient name
  6. Patient address including city, state
  7. Patient zip code
  8. Patient Date of Birth
  9. Medical Record Number
  10. Provider Federal Tax Number
  11. Patient Gender
  12. Patient race/ethnicity
  13. County of patient's residence
  14. Discharge Date
  15. Admission Source
  16. Admission Referral Source
  17. Patient Admission (S.O.C.) Date
  18. Service Dates by Discipline
  19. Total Charges
  20. Components of Charges
  21. Principal Diagnosis Code (ICD-9-CM)
  22. Other Diagnosis Codes
  23. Health Insurance Subscriber Number
  24. Primary source of payment
  25. Secondary source of payment
  26. Tertiary source of payment
  27. Discharge Status
  28. Statement Coverage Period
  29. Referring Physician NPI, SC State Licensure Number or Social Security Number

 

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