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Data Submission Tools


Outpatient Services

Outpatient Services - Owned Outpatient Services - NOT Owned
Reporting Form: Outpatient Services - Owned Reporting Form: Outpatient Services - Not Owned


Annual Filing Model Outputs consist of CDEFHPV and REV5PDA worksheets, which are part of the Annual Filings. See the Annual Report of Revenue, Expenses and Volume for more information. - Sept. 15, 2016

Rate Adjustment Data Input Worksheet - FY 2014, January

Schedule DCFA is used to collect data for the Debt Collection ⁄ Financial Assistance Report.

Re-statement of 2009 Schedule RE with supplemental information Form is used to disclose additional detail for non-operating revenue and expense.

Memorandum: Restatement of FY 2009 Schedule RE This memo to the CFOs explains the details of the above listed re-statement form.

Pension, Wage and Salary Survey Data Collection Tool is designed to automate the collection of the hospital wage and salary data as described in the Accounting and Budget Manual. - Due Annually by June 1

Community Benefits Data Collection Tool is designed to collect information on the types and scope of community benefits services provided by Maryland nonprofit hospitals. Due Date: December 15

2011 Rate Adjustment Worksheets summarizes total volume and revenue experience (inpatient and outpatient) for each hospital in the current fiscal year.

MD Hospital Data Repository Data Collection System
Revenue and Volumes Report is mandated reporting of hospitals billed charges and related volumes by rate center. This report is also submitted monthly, 30 days after the end of each month and is used to ensure hospital charging compliance with approved rates. For questions regarding the Data Collection System, please contact Amanda Vaughan.

Denied Admissions

Denied Admission Data Collection Tool Excel is designed to automate the collection of the Admissions Denied for lack of medical necessity included in the Case Mix data as prescribed in the staff recommendation approved at the August 5, 2009 Commission Meeting.- Updated 2015-07-29

Resubmission of FY 2012 Admissions Denied for Medical Necessity Report -- 2012-10-15

Denied Admissions Instructions -- 2012-10-12 Word

Admission Denied Medical Necessity Reporting -- 2010-05-07

Reporting Requirements - Admissions Denied for Medical Necessity -- 2009-10-28

Case Mix

Case Mix Audit Record Layout is used by the Commission's Auditing Vendor to audit hospital diagnostic coding as it relates to case mix.


Hospital Patient Information Sheet
According to Health-General §19-214.1(e), Maryland’s acute care hospitals must provide a patient information sheet to patients being discharged from the hospital. In order to fulfill the requirement of the statute, the HSCRC is requiring all acute care hospitals submit a copy of their information sheet to Amanda Vaughan at the HSCRC by June 19, 2009. HSCRC has developed Guidelines for the Patient Information Sheet and answers to Frequently Asked Questions in order to assist hospitals in developing their own patient information sheets. For more information, please contact Steve Ports or Amanda Vaughan at 410-764-2605.

Nurse Support Program I (NSPI) Annual Report, prepared and submitted by the Nurse Support Program I coordinator at each hospital facility, provides the HSCRC with a clear picture of how the funded nursing program is currently operating and its compliance with the regulations governing the professional and/or practical nurse education program(s) in the State of Maryland. The annual report is intended to inform the HSCRC Review Committee and the Commissioners of program operations during the preceding fiscal year.

Intern and Resident Survey (IRS) Schedule Template - The template contains a worksheet with instructions. Based on hospital feedback, on 2/23/2012 HSCRC staff added to the Schedule IRS template a column (Col 11 Percent of Rotation) in which hospitals may report a percentage of the rotation period for which a resident worked on patient care activities at the hospital. *Note that a hospital's IRS Schedule must reconcile with the hospital's IRIS (Intern and Resident Information System) Report submitted to the Medicare fiscal intermediary. If the reports do not reconcile, the hospital must submit a supplementary worksheet to HSCRC staff explaining the reasons for the differences between the reports.