Att Y - Proposed changes Annual Hospital Interview

Attachment Y: Changes to the Annual Hospital Interview

Proposed changes are indicated in RED.

• Statement added to define which questions are needed dependent on hospital level of participation.

OLD	NEW
….	For hospitals submitting their electronic data for NHCS, please complete all the questions in this interview. For hospitals not submitting electronic data, please complete only questions 1a, 1b, 4, 13, 14, and 15a.

• Added question about insurance for inpatient records and combined with original question that asked about self-pay, charity, and law enforcement separately

OLD

NEW

11. Do the data you send include records for: Discharges of patients paying their bills themselves (i.e. self-pay) Yes  No If No, how many discharges were self-pay in 2012? _______ Discharges for charity patients Yes  No If No, how many discharges were charity patients in 2012? _______ Discharges to court or law enforcement (e.g. inmates or prisoners) Yes  No If No, how many of these discharges were not billed in 2012? _______ Discharges for any other groups of patients not billing to public or private insurance (e.g. patients participating in research studies, etc)  Yes  No If No, how many of these discharges were not billed in 2012? _______

11. Do the inpatient data you send to us include records for all discharges (including those paying with public or private insurance as well as self-pay, charity, workmen’s compensation, and court or law enforcement)?  Yes  No (skip to 11b) 11a. If yes, how many (or approximately what percent) of the records you sent us for the calendar year 2014 were paid with public or private insurance (excluding workmen’s compensation)? ___________________________ 11b. If no, then approximately what number or percent of total records (including those for records not submitted) for the calendar year 2014 were for other forms of payment (self-pay, charity, workmen’s compensation, and/or court or law enforcement)? ___________________________

• Added question about charity, self-pay, and law enforcement for ambulatory records

OLD

NEW

…

12. Do the ambulatory data you send to us include records for all visits (including those paying with public or private insurance as well as self-pay, charity, workmen’s compensation, and court or law enforcement)?  Yes  No (skip to 12b) 12a. If yes, how many (or approximately what percent) of the records you sent us for the calendar year 2014 were paid with public or private insurance (excluding workmen’s compensation)? ___________________________ 12b. If no, then approximately what number or percent of total claims (including those for records not submitted) for the calendar year 2014 were for other forms of payment (self-pay, charity, workmen’s compensation, and/or court or law enforcement)? ___________________________

• Added question to collect annual and quarterly number of ED visits for the calendar year

OLD

NEW

…

Number of ED VISITS for:	Annual	Quarter 1	Quarter 2	Quarter 3	Quarter 4
All visits made to ED
Insured patients (public and private, exclude workmen’s compensation)
All other forms of payment (self-pay, charity, court/law enforcement)

• Added questions to collect annual and quarterly number of OPD visits for calendar year

OLD

NEW

…

Number of OPD VISITS for:	Annual	Quarter 1	Quarter 2	Quarter 3	Quarter 4
All visits made to OPD
Insured patients (public and private, exclude workmen’s compensation)
All other forms of payment (self-pay, charity, court/law enforcement)