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ASCPS study data request – Ambulatory surgical centers (ASCs)

Why is this study is being conducted?

The Ambulatory Surgical Center Payment System (ASCPS) study is legislatively mandated by Minnesota Statutes 176.1363. The Minnesota Department of Labor and Industry (DLI) is collecting data from ambulatory surgical centers (ASCs) about timeliness and accuracy of payments under ASCPS.

A 2018 Minnesota law changed the way workers' compensation pays for a portion of its medical care for injured workers. The law, effective October 1, 2018, establishes the Ambulatory Surgical Center Payment System (ASCPS) to reimburse ambulatory surgical centers (ASCs) for ASC facility services. The law includes the following mandate for an evaluation study:

  • "The commissioner shall conduct a study analyzing the impact of the reforms, including timeliness and accuracy of payment under this section, and recommend further changes if needed."

The results are to be reported by Jan. 15, 2021, to the Workers' Compensation Advisory Council and the relevant legislative leaders.

Data request

Who is requested to submit data?

DLI is requesting data from these Minnesota workers' compensation stakeholder groups:

  • payers, including insurers and self-insurers, that have workers' compensation ambulatory surgical center cases in Minnesota; and

  • ambulatory surgical centers that have workers' compensation cases in Minnesota.

What data is requested?

The essential data elements for the ASPCS study includes service date, service code, units of service, amounts charged and paid, bill date, payment or denial date, and other data. Specific instructions, reporting templates, instructional videos and a link to the online submission portal for each stakeholder group are located below on this webpage.

When is this data request due?

Data is due to DLI via our online submission portal by July 31, 2020.

Who can I contact with questions?

If you have questions, contact David Berry at david.berry@state.mn.us or 651-284-5208 or Brian Zaidman at brian.zaidman@state.mn.us or 651-284-5568.

Reporting instructions and materials for ambulatory surgical centers

DLI requests one data file from Minnesota ASCs about billing and payment in workers' compensation ASC cases.

Note:  The instructions and materials are designed to be viewed in sequential order. Please follow each step in the order as it is presented. Skipping a step will cause confusion.

Step 1:  Review this request letter from DLI Commissioner Nancy Leppink for ASCs. This letter explains the statute background, why DLI is making this request and why it is important for you to complete this data request.

Step 2:  Download step-by-step instructions for ASCs (PDF) as of April 30. These written instructions are for your reference as you complete this data request. Please have them open for your reference at all times.

Step 3:  Watch this 7-minute video to get an overview of this data request for ASCs. This video contains important parameters, tips, advice and instructions.

Step 4:  Download and review the reporting template (Excel) as of April 30. Please review each tab in order from left to right. Start by reading the Background tab. Please make sure to read the "Data Request Overview" section located in the Background tab to gain an understanding of the parameters of this request – what data elements it includes and excludes. This information is also explained in the instructional video 1 for ASCs.

The Instructions tab is for your reference, so you can go back to it as needed.

It is important you complete the Payer Data tab first, then complete the BP Data with PPO Adjustments tab second, then lastly complete the BP Data without PPO Adjustment tab. Skipping out of order will cause confusion.

Step 5:  Complete the Payer Data tab in the Excel reporting template. This is a necessary step to help you identify which cases to report. Refer to the PDF instructions you downloaded in Step 2 and watch ASCPS Insurers instructional video for an illustration of how to complete this tab.

Step 6:  Complete the Billing and Payment Data with PPO Adjustment tab in the Excel reporting template. This is where you report detailed data for PPO cases identified in Step 5. Refer to the PDF instructions you downloaded and watch ASCPS Insurers instructional video for an illustration of how to complete this tab.

Step 7:  Complete the Billing and Payment Data without PPO Adjustment tab in the Excel reporting template. This is where you report detailed data for non-PPO cases identified in Step 5. Refer to the PDF instructions you downloaded and watch the ASCPS Insurers instructional video for an illustration of how to complete this tab.

Step 8:  Submit the completed data file via the online portal. This step is straightforward. For an illustration about how to do this, watch the instructional video.

Important links and files

Frequently asked questions

General questions

Q:  What about data confidentiality? Is my organization able to share the requested data with DLI?

A:  This data request involves only de-identified payment and billing data. DLI will only use this information to assess the timeliness and accuracy of the ASCPS system. Only aggregated, de-identified results will be published. The report generated from this information will only include summary data – that is, statistical records and reports derived from data about individuals but in which individuals are not identified and from which neither their identities nor any other characteristic that could uniquely identify an individual are included. See Minnesota Statutes sections 13.02, subd. 19, and 13.05, subd. 7. The published reports will also not identify specific payers.

Q:  Is this work required?

A:  DLI is required to conduct this study under Minnesota Statutes 176.1363. The Legislature mandated that DLI collect data from insurers, self-insurers and ASCs about timeliness and accuracy of payments under the Ambulatory Surgical Center Payment System (ASCPS).

Q:  What is the reporting period?

A:  This data request concerns patient encounters paid under ASCPS with service dates from April 1 to Dec. 15, 2019.

Q:  When is this data request due?

A:  This data request is due July 31, 2020.

Q:  What if my organization doesn't have any reportable encounters that fit the criteria of this data request?

A:  If you don’t have any reportable encounters, you only need to fill in the ASC Data tab and submit the Excel file online. This helps DLI track which organizations completed the data request and have no reportable encounters. Please read the Background tab and Instructions tab (also available in PDF) and watch instructional video 3 for guidance about how to complete the ASC Data tab.

Q:  I'm dealing with missing and/or erroneous data and cannot fill in every detail for each encounter and/or service. What should I do?

A:  If you are dealing with missing and/or erroneous data, leave the data item blank.

ASC data tab questions

Q:  Is it up to the ASC to decide if they want to report all patient encounters or only a sample?

A:  Yes, the choice of whether to report all population encounters or just a sample is specific to the ASC.

Q:  How do I know what number of population encounters to put in columns F through G?

A:  By pulling data from the payer's database using the criteria for "countable encounters" provided in the instructions you will know what number of population encounters to include. In summary, the criteria for a countable encounter are:  (1) the encounter is covered by the Minnesota workers' compensation Ambulatory Surgical Center Payment System (ASCPS); (2) the encounter is at least partially paid (not fully denied); (3) the amount paid for the encounter is not affected by a settlement; and (4) the encounter has a service date from April 1 to Dec. 15, 2019.

Q:  What should I do about PPO cases versus non-PPO cases?

A:  You will report encounters with PPO adjustments separately from encounters without PPO adjustments. This is explained in the Instructions Tab in the Excel reporting template, as well as in instructional video 1 for ASCs.

Q:  What is PPO? How do I know if an encounter has any PPO adjustment? 

A:  PPO stands for preferred provider organization. Some ASCs have an agreement with a PPO that dictates payment differently than the ASCPS. To identify an encounter with PPO adjustment, look on the 835 remittance advice. A PPO adjustment is indicated by:  a CARC value of P24 for segment CAS02, CAS05, CAS08, CAS11, CAS14 or CAS17 within loop 2110 or 2100; or by a CARC value of 96 for one of these same segments along with a remittance advice remark code (RARC) value of N381 for segment LQ02 within loop 2110 where segment LQ01 is HE.

Q:  How do I know what number of sample encounters to put in columns Q through R?

A:  After you have chosen whether to report about all population encounters or a sample for each payer (as you indicate in column I or J), each ASC will be assigned a sample date window in columns K through P. For each ASC, use their sample date window to refine your query and pull case counts from the ASC's database that fit within their assigned sample window. Make sure you separate encounters with PPO adjustment from encounters without PPO adjustment. After you have numbers to put into columns Q and R, these selected encounters are what you will report in detail on the next two tabs.

BP data with PPO adjustment tab questions

Q:  What should I do if my ASC has zero encounters with PPO adjustment?

A:  If an ASC has no encounters with PPO adjustments, fill out nothing for that ASC in this tab. If all ASCs for whom you are reporting have zero encounters with PPO adjustment, leave this tab blank and move on.

Q:  Do I report details of encounters with PPO adjustment for all ASCs on the same tab?

A: Yes, for each encounter you report, you will report the ASC Name to identify the ASC.

BP data without PPO adjustment tab questions

Q:  The instruction says "Report one line for each service for each sample encounter without a PPO adjustment." That sounds like a lot of detailed data. Do I have to report one line for each service for each encounter?

A:  Yes, you have to report one line for each service for each encounter. This is needed for DLI to assess payment accuracy.

Submitting data file online questions

Q:  What is the link to get to the online submission portal?

A:  The online submission portal is at https://secure.doli.state.mn.us/dlidata20/.

Q:  In what scenario would someone have multiple files to submit?

A:  An ASC group administrator might elect to submit one file for each ASC for which it is reporting. However, the option exists to report for all ASCs concerned in the same submission.

Q:  How do I know the files are received? Do I get a confirmation?

A:  You will see a confirmation when your completed files have been successfully uploaded to DLI.

Questions?

If you have questions, contact David Berry at david.berry@state.mn.us or 651-284-5208 or contact Brian Zaidman at brian.zaidman@state.mn.us or 651-284-5568.