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HOFS Study Data Request – Hospitals

Why is this study being conducted?

The Hospital Outpatient Fee Schedule (HOFS) study is legislatively mandated by Minnesota Statutes 176.1364. DLI is collecting data from insurers and hospitals on timeliness and accuracy of payments under HOFS.  

A 2018 Minnesota law changed the way workers’ compensation pays for a portion of its medical care for injured workers. The law, effective Oct. 1, 2018, establishes the Hospital Outpatient Fee Schedule (HOFS) to reimburse non-Critical-Access hospitals for outpatient facility services. The law includes the following mandate for an evaluation study:

  • “The commissioner (of Labor and Industry) shall conduct a study analyzing the percentage of claims with a service in the HOFS that were paid timely and the percentage of claims paid accurately.”

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 hospital outpatient cases in Minnesota;

  • Non-critical-access hospitals that have workers’ compensation outpatient cases in Minnesota.

What data is requested?

The essential data elements for the HOFS study includes service date, service code, units of service, amounts charged and paid, bill date, and 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 listed below.

When is this data request due?

Data is due to the Minnesota Department of Labor and Industry via our online submission portal by July 31, 2020.

Who can I contact with 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.

Reporting instructions and materials for hospitals

DLI requests one data file from Minnesota hospitals about billing and payment in workers’ compensation HOFS cases.

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

Step 1:  Review the request letter from DLI Commissioner Nancy Leppink for hospitals. 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 hospitals (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 hospitals. 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. 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 hospitals.

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 had downloaded in Step 2 and watch hospitals HOFS instructional video Part 2 for an illustration of how to complete this tab.

Step 6:  Complete the Billing and Payment Data with PPO Adjustments tab in the Excel reporting template. This is where you report detail data for PPO cases identified in Step 5. Refer to the PDF instructions you downloaded and watch hospitals HOFS instructional video Part 3 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 detail data for non-PPO cases identified in Step 5. Refer to the PDF instructions you had downloaded and watch hospitals HOFS instructional video Part 4 for an illustration of how to complete this tab.

Step 8:  Submit your completed data file via online portal. This step is straightforward. For an illustration of how to do this, watch instructional video Part 5.

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 HOFS 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:  The Minnesota Department of Labor and Industry (DLI) is required to conduct this study under Minnesota Statutes 176.1364. The Legislature mandated that DLI collect data from insurers, self-insurers and hospitals about timeliness and accuracy of payments under the Hospital Outpatient Fee Schedule (HOFS).

Q:  What is the reporting period?

A:  This data request concerns patient encounters paid under HOFS with service dates from Nov. 4 to Dec.18, 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 cases or 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 Hospital Data tab and submit the Excel file online. This helps DLI track which hospitals 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 Hospital 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:  Leave the data item blank if you don't have the data.

Hospital data tab questions

Q:  Is it up to the hospital 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 hospital.

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

A:  By pulling data from the hospital's database using the criteria for "countable encounters" provided in the instructions will determine what number of population encounters to put in columns F through G. In summary, the criteria for a countable encounter are:  (1) the encounter is covered by the Minnesota workers' compensation Hospital Outpatient Fee Schedule (HOFS); (2) the encounter is at least partially paid (or not fully denied); (3) the amount paid for the encounter is not affected by a settlement; and (4) the encounter has a service date between Nov. 4 and Dec. 18, 2019. When you pull data, please separate encounters with PPO adjustments from those without PPO adjustments.

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 hospitals.

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

A:  PPO stands for preferred provider organization. Some insurers have an agreement with a PPO that dictates payment differently than the HOFS. 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 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 on all population encounters or a sample for each hospital (as you indicate in column I or J), each hospital will be assigned a sample date window in columns K through P. For each hospital, use its sample date window to refine your query and pull case counts from the hospital'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 a hospital has zero encounters with a PPO adjustment?

A:  If a hospital has zero encounters with a PPO adjustment, fill in nothing for that hospital in this tab. If all hospitals 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 adjustments for all hospitals on the same tab?

A:  Yes, for each encounter you report, you will report the hospital name to identify the hospital.

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. However, for encounters that have at least one non-denied service with a J1 status indicator, you only need to report those services with a J1 or H status indicator. 

Q:  Where can I find a service's status indicator under HOFS?

A:  Under HOFS, the J1, J2 and H status indicators are the only ones that matter for payment. These can be found at www.dli.mn.gov/business/workers-compensation/work-comp-medical-fee-schedules-hofs.

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:  A hospital group might decide to submit separate files for different member hospitals, but it may be more convenient to report for all member hospitals in the same submission. You can upload all files at the same time.

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

A:  You will receive 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.