MIRCal – Glossary
- Ambulatory Surgery Data
For each encounter during which at least one ambulatory surgery procedure is performed, each hospital and freestanding ambulatory surgery clinic shall submit an ambulatory surgery data record, as specified in Subsection (a) of Section 128737 of the Health and Safety Code, for each encounter during the quarterly reporting period, according to the format specified in Subsection (c) of Section 97215 and by the dates specified in Subsection (c)(3) of Section 97211. An ambulatory surgery procedure is defined by Subsection (a) of Section 128700 of the Health and Safety Code as those procedures performed on an outpatient basis in the general operating rooms, ambulatory surgery rooms, endoscopy units, or cardiac catheterization laboratories of a hospital or a freestanding ambulatory surgery clinic. A hospital shall not report an Ambulatory Surgery Data Record if the encounter resulted in a same-hospital admission. 3
- Ambulatory Surgery Procedures
Those procedures performed on an outpatient basis in the general operating rooms, ambulatory surgery rooms, endoscopy units, or cardiac catheterization laboratories of a hospital or a freestanding ambulatory surgery clinic.1
- Approval Criteria
Those tests performed which are intended to determine compliance with the reporting requirements and specifications included in the California Code of Regulations, Title 22, Division 7, Chapter 10, Article 8 Data Reporting Requirements.
- California Hospital Discharge Data Set
The California Hospital Discharge Data Set consists of the data elements of the hospital discharge abstract data record, as specified in Subdivision (g) or Section 128735 of the Health and Safety Code.
- Data Submitter
Either the Health Care Facility or the facility's Designated Agent.
- Designated Agent
An entity designated by the reporting facility to submit its data records to the Office's Data Program through MIRCal.
A discharge2 is defined as an inpatient2 (inpatient: a baby born alive in this hospital or a person who was formally admitted to the hospital with the expectation of remaining overnight or longer) who
- is formally released from the care of the hospital and leaves the hospital, or
- is transferred within the hospital from one type of care to another type of care, as defined by Subsection (x) of Section 97212, or
- leaves the hospital against medical advice, without a physician's order or is a psychiatric patient who is discharged as away without leave (AWOL) or
- has died
- Electronic Transmission
Transmission of a digital data report over telecommunications systems/networks.
- Emergency Department
In a hospital licensed to provide emergency medical services, the location in which those services are provided.1
- Emergency Care Data
Each hospital shall submit an emergency care data record, as specified in Subsection (a) of Section 128736 of the Health and Safety Code, for each encounter during the quarterly reporting period, according to the format specified in Subsection (b) of Section 97215 and by the dates specified in Subsection (c)(2) of Section 97211. A hospital shall not report an Emergency Care Data Record if the encounter resulted in a same-hospital admission.3
A face-to-face contact between a patient and the provider who has primary responsibility for assessing and treating the condition of the patient at a given contact and exercises independent judgment in the care of the patient.1
Extension of time to file data reports is available to facilities that are unable to complete their submission of data reports by the due date prescribed in Regulation.
- Freestanding Ambulatory Surgery Clinic
A surgical clinic that is licensed by the state under paragraph (1) of subdivision (b) of Section 1204. 1
- Health Care Facility
A licensed Hospital, Emergency Department, or Ambulatory Surgery Center as defined in Section 128700 of the California Health and Safety Code.
- HIPAA - Health Insurance Portability and Accountability Act
Health Insurance Portability and Accountability Act of 1996 (HIPAA). The Administrative Simplification (AS) provisions of this Act are intended to reduce the costs and administrative burdens of health care by making possible the standardized, electronic transmission of many administrative and financial transactions that have been carried out manually on paper.
- HID - Healthcare Information Division
Division of the Office of Statewide Health Planning and Development that has responsibility for the collection and dissemination of healthcare data, and produces data analyses and other products.
- HIRC - Healthcare Information Resource Center
A section within the Healthcare Information Division of the Office of Statewide Health Planning & Development, responsible for public and nonpublic analysis and dissemination, including custom requests, of healthcare data collected by OSHPD's Healthcare Information Division and the California Department of Public Health.
Reporting facilities may file a request with the Office for modifications to the California Hospital Discharge Data, Emergency Care Data, or Ambulatory Surgery Data reporting requirements. The modification request must be supported by a detailed justification of the hardship that full reporting of data would have on the reporting facility; an explanation of attempts to meet data reporting requirements, and a description of any other factors that might justify a modification. Pursuant to Section 97240 in Title 22 of the California Code of Regulations, a modification to required reporting may be issued by the Office on historical data after communication and determination with the facility regarding erroneous data exceeding error tolerance levels and non-compliant with required reporting. Modifications may be granted for no more than one year. Modifications to reporting requirements are subject to disclosure to data users, labeled with Data Exceptions.
- MS-DRG - Medicare Severity Diagnosis Related Group
is a classification scheme with which to categorize patients according to clinical coherence and expected resource intensity, as indicated by their diagnoses, procedures, age, sex, and disposition, and was established and is revised annually by the U. S. Centers for Medicare and Medicaid Services (CMS).
- On-line Transmission see Electronic Transmission
An outpatient is a person who has been registered or accepted for care but not formally admitted as an inpatient and who does not remain over 24 hours, as specified in Subsection (a) (2) of Section 70053 of Title 22 of the California Code of Regulations, or a patient at a freestanding ambulatory surgery clinic who has been registered and accepted for care. 2
When a health care facility has not submitted a data report in accordance with the provisions of Subdivision (g) of Section 128735 and Subdivision (c) of Section 128755 of the Health and Safety Code, and the facility has not been granted a modification or extension, it is liable for a civil penalty of one hundred dollars ($100) per day for each calendar day the filing of any report is delayed as defined in Section 128770 of the Health and Safety Code. Civil penalties are to be assessed and recovered in a civil action brought in the name of the People of the State of California by the Office. A health facility may request an appeal and the penalty may be reduced or waived for good cause. Penalties received by the office pursuant to this section shall be paid into the General Fund.
The person who has primary responsibility for assessing and treating the condition of the patient at a given contact and exercises independent judgment in the care of the patient. This would include, but is not limited to, a practitioner licensed as a Medical Doctor (M.D.), a Doctor of Osteopathy, (D.O.), Doctor of Dental Surgery, (D.D.S.), or Doctor of Podiatric Medicine, (D.P.M.). 2
The set of data elements specified in Subsection (g) of Section 128735, Subsection (a) of Section 128736, or Subsection (a) of Section 128737 of the Health and Safety Code, for one discharge or for one encounter. 2
A report is defined as the collection of all records submitted by a hospital or freestanding licensed ambulatory surgery clinic for a designated reporting period.
1 Health and Safety Code, Section 128700
2 Title 22, California Code of Regulations, Section 97212
3 Title 22, California Code of Regulations, Section 97213
This page was last updated on Friday, December 9, 2016.