Information Bulletin, June 2010

Contact us at:

E-mail: sparcs.submissions@health.ny.gov
Phone: (518) 473- 8144 or (800) 638-3808


Inpatient APR-DRG Available
SPARCS Civil Penalty Fee
Reminder: Inpatient Reporting for Source of Payment Typology 2010 Data
Clarification: Reporting Emergency Room Point of Origin for Admission or Visit

Inpatient APR-DRG Available

The All Patient Refined Diagnostic Related Grouper (APR-DRG) has been added to the inpatient output files available for facilities and researchers. This information is used to categorize patient records for reimbursement and research purposes. The software, which was developed by 3M Health Information Systems, calculates and assigns the following data elements to the claim:

  • APR-DRG
  • Major Diagnostic Category (MDC)
  • Severity of Illness Score
  • Risk of Mortality Score

This information is specific to the calendar year of the date of discharge, based upon the appropriate version of the software for that year. The information on the grouper versions can be found in Appendix Y at www.nyhealth.gov/statistics/sparcs/sysdoc/appy.htm. Thus, for each year of discharge, the appropriate version was applied to the claim to produce the results for each data element above for the following:

  • Current Version
  • Prior Version
  • New Version

The Inpatient Output Data Dictionary Table of Contents for each of these data elements can be found at: www.nyhealth.gov/statistics/sparcs/sysdoc/iptable.htm

The complete file layout description can be found in Appendix V at: www.nyhealth.gov/statistics/sparcs/sysdoc/appv1.htm. The data elements described above are located in positions 1955 thru 1975 on this output file.

Facility Instructions: Health facility personnel with SPARCS upload permissions have access to the Health Facilities Own Data download function. Inpatient-only health care facilities have the APR information on their data file. The following instructions are for downloading facility data using the Health Commerce System (HCS) Portal:
  • From the My Application (left side), select any of the SPARCS applications: SPARCS Data Queries, SPARCS Data Submission, SPARCS Performance Metrics or SPARCS Quality Reporting.
  • For easier display, you may close the HCS My Application by clicking the orange box at the top of the My Application (next to the NYS state icon).
  • For the SPARCS application selected, select Data/Report Requests at the top of the listed functions. The same functions are displayed on the left side of the page for each SPARCS application. (Note: if you have access to more than one facility, you will be prompted to select the appropriate facility. Select Apply after you have made your selection.)
  • On the SPARCS Data Submission and Data/Report Request page select Data/Report Request.
  • On the SPARCS Data Report System page there are two pick-lists:
    • From the first pick-list, System Type, select Inpatient.
    • From the second pick-list, Data/Report Request, select Health Facilities Own Data by Year, Month(s).
    • Select Continue.
  • On the next page you must enter the year, beginning month, and ending month for the desired time frame. Most importantly, you must select the appropriate version SPARCS Output Format and click Send to start the request to process the data in the format detailed in Appendix V.
  • The data file will be posted under the SPARCS Submission Results page under Health Facilities Own Data for you to download, usually within two hours of the request.
Researcher Instructions:

SPARCS Civil Penalty Fee

Fortunately, most facilities comply with SPARCS reporting requirements and are unaware that civil penalty fees can be assessed. For those that do not comply with SPARCS reporting requirements, there is an assessment of a civil penalty fee of $2000 per month per type of data (Ambulatory Surgery, Inpatient, or Emergency Department data). The civil penalty fee is assessed after going through the enforcement process. How does a facility reach enforcement? The enforcement process begins after failing two Statement of Deficiency (SODs) processes. For example: if a facility fails to submit SPARCS Ambulatory Surgery and Inpatient data for three months and fails two SODs, it would receive a civil penalty of $12,000 (3 months x 2 types of data sets x $2,000).

Reminder: Inpatient Reporting for Source of Payment Typology 2010 Data

The July 1, 2010 deadline for the implementation of required data elements in the Source of Payment Typology (SoP) is fast approaching. Please be aware that the July 1, 2010 deadline still stands and no exceptions will be allowed. Hospitals will be expected to report these data elements for all inpatient 2010 discharges. The SoP is crucial for various projects within the Department of Health and we will need a full year of inpatient reporting for these elements. (Keep in mind this requirement was originally announced in October 2008 with a complete transition expected by December 31, 2009. The deadline was changed to July 1, 2010 to accommodate facilities). Your facility will have time to correct any 2010 inpatient data until June 30, 2011. If you need additional help or information regarding the submission of these data elements, please contact our SPARCS Administrative Unit.

Clarification: Reporting Emergency Room Point of Origin for Admission or Visit

The National Uniform Billing Committee (NUBC) announced a change to the FL 15 data element, Point of Origin for Admission or Visit, to be effective July 1, 2010. Specifically, the announcement was to delete code 7 for reporting Emergency Room. NUBC also announced the creation of a new Condition Code (FL 18-28) with the value of P7 for public health reporting for Direct Inpatient Admission from Emergency Room, to replace the usage of the Point of Origin value. For SPARCS, the expression, timing is everything, comes into play. Due to the creation of a new SPARCS system, changes to our existing system are being minimized. SPARCS will continue to accept the value of 7 for Emergency Room in the Point of Origin data element recognizing the fact that some facilities may not be able to continue to report the value of 7 for Emergency Room. If your systems have the ability to continue reporting the value of 7 to SPARCS, it will continue to be accepted. Once SPARCS has a new system, the edit will be adjusted for the Point of Origin; at the same time, a new Condition Code will be added for reporting Direct Inpatient Admission from Emergency Room. We are suggesting that if you are making a change to the Point of Origin, you should make the adjustment to the Condition Code which will be collected in the near future. This way, your systems will be ready before SPARCS asks for the Condition Code!