Delaware Code Title 16 Sec. 2004 – Reporting requirements
(a) The Delaware uniform claims and billing data set (UB-82 or successor form) shall be completed for all hospital inpatient discharges and shall be submitted by all hospitals to the state agency according to a schedule established pursuant to subsection (d) of this section. All third-party payers shall be required to accept this uniform claims and billing form. The state agency shall recognize the capabilities of each hospital in specifying the medium or mediums to be used in submitting data (hard copy, data tape or other appropriate electronic media).
Terms Used In Delaware Code Title 16 Sec. 2004
- Delaware uniform claims and billing data set: shall mean that data approved for use by the State Uniform Billing Committee. See Delaware Code Title 16 Sec. 2002
- Hospital: shall mean any nonfederal facility licensed as such pursuant to Chapter l0 of this title. See Delaware Code Title 16 Sec. 2002
- Individual: shall mean a singular human being. See Delaware Code Title 16 Sec. 2002
- Nursing home: shall mean any and all rest residential, assisted living facility, skilled care or intermediate nursing facility licensed pursuant to Chapter 11 of this title. See Delaware Code Title 16 Sec. 2002
- State: means the State of Delaware; and when applied to different parts of the United States, it includes the District of Columbia and the several territories and possessions of the United States. See Delaware Code Title 1 Sec. 302
- State agency: shall mean the Division of Public Health within the Department of Health and Social Services. See Delaware Code Title 16 Sec. 2002
- Third-party payers: shall mean any person authorized to transact health insurance or to engage in the business of a health service corporation in this State. See Delaware Code Title 16 Sec. 2002
(b) The Delaware uniform claims and billing data set (UB-82 or successor form) shall be completed for all nursing home inpatient discharges beginning not sooner than June 30, 1995, and shall be submitted by all nursing homes to the state agency according to a schedule established pursuant to subsection (d) of this section. All third-party payers shall be required to accept the Delaware uniform claims and billing form. Prior to this time, nursing homes shall continue to submit data in a medium and format as agreed to by the state agency and the Delaware Health Care Facilities Association.
(c) The state agency shall assure that any report of data specific to hospitals or nursing homes presents data that are reliable, valid and informative. Such data shall reflect, as appropriate, factors including, but not limited to, the number of patients, patient severity at admission, age of patients, the actual versus expected number of deaths, average length of stay and case mix. The report shall explain each of these adjustments. The report also shall include information necessary to adequately represent the operations of the individual hospital or nursing home such as whether or not physician charges are included in the hospital charges, whether or not the hospital maintains medical education programs and the hospital’s payer mix. The state agency shall consult with the Association of Delaware Hospitals and the Delaware Health Care Facilities Association in identifying the various adjustment factors and information to be included.
(d) The state agency shall establish schedules for the timely submission of data and information collected pursuant to this section. The state agency may grant waivers from such schedules for good cause shown.