DATA VALIDATION REQUIREMENTS
CY 2012 OPPS/ASC FINAL RULE
Data Validation Requirements for CY 2013 Payment
Summary
Validation is designed to verify that data abstracted by hospitals for the Hospital
OQR Program are accurate and consistent based upon the percent agreement between
the hospitals and the CMS Clinical Data Abstraction Center (CDAC) abstractions.
The results of validation will affect the CY 2013 payment update
for the selected hospitals [CY 2012 OPPS/ASC Final Rule (42 FR Parts 410, 411, 412,
et al.)].
Procedure
For the CY 2013 Outpatient Prospective Payment System (OPPS) payment determination,
the CDAC is requesting medical records beginning with encounter dates of April 1,
2011 from 450 randomly selected hospitals and 50 targeted hospitals, with up to
12 records requested per hospital per quarter. The targeted hospitals will be selected
based upon either failing the validation requirement or having outlier values in
the hospital’s submitted data. To receive the full OPPS payment update, hospitals
must obtain at least a 75 percent validation score, based upon the validation process,
for the designated time period.
The list of the 500 selected hospitals is posted on the QualityNet website. These 500 hospitals are required to send in records quarterly for one year; it is possible for a hospital to be selected in consecutive years.
Once the random selection has been completed, the CDAC uses U.S. Postal Service Certified Mail to request that each selected hospital submit its supporting medical record documentation that corresponds to each selected case. Hospitals must supply the medical record for each requested case by the established deadline or risk a 2.0 percent reduction in their annual payment update.
Each hospital must submit this documentation to the CDAC within 45 calendar days of the date of the request (as documented on the request letter). If the hospital fails to comply within 30 days of the initial medical documentation request, the CDAC will send a second certified letter to the hospital reminding it that the requested documentation must be received within 45 calendar days following the date of the initial request. If the hospital still fails to comply, a “zero” score will be assigned to each data element for each selected case and the case will fail for all measures in the same topic (for example, OP-6 and OP-7 measures for a surgical care case).
Reports detailing a listing of all cases selected for validation including all available patient identifiers can be accessed on My QualityNet for any user who has the HOP QDRP Feedback Reports role. The case list can be found on the www.QualityNet.org website. Sign in to the secure area of My QualityNet and access Reports: Run; Report Category: HOP QDRP Validation Reports, Case Selection Report. These reports are not available until 7-10 days after the date on this request for medical records.
Once the CDAC receives the requested medical documentation, it independently re-abstracts the same quality measure data elements that the hospital previously abstracted and submitted and compares the two sets of data to determine whether they match.
- Initial Request for Outpatient Medical Records (sample CDAC letter)
- Second/Final Request for Outpatient Medical Records (sample CDAC letter)
- Instructions for Submitting Outpatient Medical Records
- Data Validation Educational Reviews