The Health Care Quality Assessment Program of the Office of the Commissioner of the Department of Health and Senior Services (Department) is proposing amendments at N.J.A.C. 8:31B-1.2, General Provisions and N.J.A.C. 8:31B-2.1 and 2.5, Hospital Reporting of Uniform Billing Data (Inpatient, Same-Day Surgery and Emergency Department Outpatient).  The notice of proposal appears in the June 18, 2007 issue of the New Jersey Register.

The Department collects uniform billing data from all New Jersey acute care general hospitals for inpatients, same-day surgery outpatients, and emergency department visits in order to set Medicaid inpatient fee-for-service rates, allocate certain disproportionate share hospital subsidies for acute care general hospitals, and for public health purposes.  Public health purposes include, identifying and analyzing treatment patterns, patient demographics, prevalence of diseases and/or injuries, and collection of baseline data to gauge potential bioterrorism events.

The Department proposes an amendment at N.J.A.C. 8:31B-2.1(a) to change the form used for collecting this data from the “UB-92, HCFA-1450” to the “UB-04, CMS 1450” in order to maintain consistency with Federal changes.  The Centers for Medicare and Medicaid Services (CMS) have updated the UB-92 to the UB-04 and require the new form as of May 23, 2007.  Consequently, the Department proposes an amendment to the definition of “Uniform Bill-Patient Summary” at N.J.A.C. 8:31B-1.2 to remove “UB-82,” the form used for data collection prior to the “UB-92, HCFA-1450,” and replace that term with “UB-04, CMS 1450.”

The Department proposes an amendment at N.J.A.C. 8:31B-2.1(a) to change the electronic format for transmission of the uniform billing data by acute care general hospitals to the Department from a Health Insurance Portability and Accountability Act of 1996 (HIPAA) Pub.L. 104-191, “HIPAA-compliant" format, which is the Health Care Claim: Institutional 837 Version 4010 (Version 4010) to the “HIPAA-compatible Health Care Service: Data Reporting 837 Version 5010” (Version 5010).  The Department proposes the amendment to require Version 5010 because it better meets the needs of government agencies that collect billing data for reporting purposes rather than billing adjudication.  The Department proposes an amendment at N.J.A.C. 8:31B-2.1(a) to clarify that there would be a required format for reporting the uniform billing data by changing “may be transmitted” to “shall be transmitted.”  The Department proposes an amendment at N.J.A.C. 8:31B-2.5(g)1 to change the name of the instructions for formatting and contents of the New Jersey specific uniform billing data from “HIPAA-Compliant ANSI ASC X12 Addendum Guide” to  “New Jersey ANSI ASC X12 837 Addendum Guide.”

The public has until August 17, 2007 to comment on the notice of proposal.  Persons wishing to comment on the proposal must submit their comments in writing to Emmanuel A. Noggoh, Director, Department of Health and Senior Services, Health Care Quality Assessment Program, PO Box 360, Trenton, NJ 08625-0360.  Written comments on the proposal must be postmarked on or before August 17, 2007, which is the close of the 60-day public comment period.

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