||Likely Cause of Failure
for proper file format and compares the “Expected” (based on the
Transmittal Page information) to “Actual” data submitted. Checks for:
- Virus infected file
- No data in file
- Multiple files in the ZIP file
- Incorrect file format
- Discrepancy in the number of records submitted vs. the number entered on the Transmittal screen.
- One (1) or more records are reported with a Discharge Date that is blank, invalid, or outside the Report Period.
- Incorrect Facility ID number in any record
- MIRCal Database errors
|Your data did not pass one or more of the transmittal validations.
to make sure your data includes all the types of care and services for
which your facility is licensed. For example, if your facility is
licensed for Acute care, but no records are reported as Acute type of
care, your data will fail this program.
NOTE: This program does not check for records that include a type of care for which your facility is not licensed. The Standard Edit program identifies this type of error.
|Your facility is licensed for a specific type of care, but that type of care is not being reported on any of your records.
the data in the current report period to your facility's historical
data to identify uncharacteristic increases or decreases in percentages
reported for certain data element categories.
In the current report period, your facility reported 65% Non-Hispanic
patients, but in the previous two(2) report periods, you reported only
20% Non-Hispanic patients. If this percentage difference between report
periods is outside the “Allowable Difference,” either a Critical or
Non-Critical Trend flag is generated. Non-Critical flags will not cause
your data to fail this program, but one or more Critical flags will.
|Your data caused the program to generate one or more Critical Trend flags.
on the TOTAL records reported, checks for reasonable distribution of
categories within each data element for the current report period.
100% of your records are reported with Patient Disposition–Routine,
this program will generate a Comparative Edit flag and your data will
|Your data caused the program to generate one or more Comparative Edit flags.
|Records with a Blank or Invalid Principal Diagnosis
program identifies records with a Principal Diagnosis that is blank,
invalid, reported with an "old" diagnosis code after the effective End
Date; or reported with a "new" diagnosis code before the effective
Begin Date. The erroneous Principal Diagnosis code will receive a
||One or more records with a Blank or Invalid Principal Diagnosis.
for data entry errors and inconsistencies of data reported within each
EXAMPLE: Admit Date is AFTER the Discharge Date.
|More than 2% of your records contain standard edit errors.
for illogical combinations of ICD-9-CM codes.
EXAMPLE: It is
illogical for a record to have a Principal Diagnosis code for a normal
birth and a Procedure code for a C-section.
|More than 2% of your records contain coding edit errors.
records that contain identical Social Security numbers (SSNs), and then
checks for inconsistencies between the records.
records with the same SSN cannot have different Dates of Birth; either
the SSN or the Date of Birth is incorrect.
This program also checks for errors in transfers to a
different type of care.
EXAMPLE: A patient is transferred within
your hospital from Acute Care to SN/IC on the same day. The Patient
Disposition in record 1 is reported as “04 SN/IC within hospital,” but
the Source of Admission in record 2 is reported as “132 Home.” This
would cause a re-admission error. The Source of Admission in record 2
should be reported as “51x Acute Inpatient within your hospital.”
|More than 2% of your records contain re-admission edit errors.