1. 1 RSR Ryan White HIV/AIDS Program Services Reporting System “First Steps for Data Flow” RSR Part Three

2. 2 Three-Part Orientation Series: Ryan White Services Report (RSR) Part 1: A Brief History of Data Reporting and Moving to Client-level Data - December 8, 2008 http://www.careacttarget.org/datacollection.asp Part 2: Who, What, When, Why and What’s New – December 15, 2008 http://www.careacttarget.org/datacollection.asp Part 3: “First Steps for Data Flow” - TODAY January 12, 2009 Essential Steps in Data Flow: http://careacttarget.org/library/rsr/EssentialStepsinD ataFlow1111.pdf

3. 3 Reminder: RSR Reference Sources Website: http://careacttarget.org/rsr.asp: –Data Steps for data collection and reporting –Instruction Manual for the RSR Instruction (V1.2) –Required Data Elements for the Client Report –Sample forms, timeline, and archived web casts –Email address for RSR questions: RSR.TA@sphereinstitute.org –Coming soon: FAQs Project Officers

4. 4 Seven Essential Steps in Data Flow Identify and Define Data Elements Identify Data Sources  Collect Data  Validate and Assess Data Quality  Report Data  Communicate About Data  Use Data to Inform Your Program’s Operations http://careacttarget.org/rsr.asp

5. 5 Step 1: What do you need to report? Identify RSR data elements and use HAB definitions from these sources Required Data Elements for the Client Report and Instruction Manual for RDR Remember that you have been collecting and reporting most of the required RSR data in RDR –Data for the Grantee Report – the same –Data for the Provider Report – nearly identical

6. 6 Step 1: What do you need to report? Once you identify data elements and review the HAB definitions, you can simplify data collection if you Use the data sources and documents we are going to suggest for ease of collection Focus on collecting data and remember that XML can reformat the data for the RSR submission Data Inventory Training is coming…

7. 7 Step 2: Where can you find it? Client Level Report Data/Clinical Information Data Sources for RSR Questions 46 to 66  electronic health record, medical record, third party billing systems or lab reports Enrollment, case management or medical record progress notes Clinical information for each RW HIV-positive or indeterminate client, regardless of who paid In the slides that follow, we will present examples of data needed and places to find the information

8. 8 Recap:Clinical Information Easier Where can you get the data you need? The Chart There are data sources for much of the clinical information you need for the RSR –Look to your billing system…it’s usually electronic, and this may decrease cost and improve data collection. –Some examples follow

9. 9 But First, a Brief Look at Code Sets Standard Code Sets for Health Care Data –CPT: Common Procedure Terminology (AMA) –ADA: American Dental Association procedures –HCPCS: Healthcare Common Procedure Coding System (CMS) –ICD-9: International Classification of Diseases, 9 th Edition –NDC: National Drug Codes (HHS)

10. 10 Clinical Information – First Visit Q 47. First outpatient/ambulatory care visit –Look in your billing system for new visit data for clients with ICD9-CM code 042 – HIV, symptomatic –Remember, this is the first visit and it may not fall within the current reporting dates –Scan for visit codes such as: 99201 – New, Brief 99202 – New, Limited 99203 – New, Intermediate 99204 – New, Extensive 99205 – New, Comprehensive

11. 11 Clinical Information - Visit Q 48 Outpatient/ambulatory care visit dates (examples): –Look in your billing system for patients with visits that have the ICD9-CM code of 042. (HIV, symptomatic) This will provide a great starting list. –Look in your billing system for the dates of these visits, and the kind of visit. 99211 99212 99213 99214 99215

12. 12 Clinical Information- CD4 tests Q 49. CD4 Cell Counts –Look in your billing system for these codes: 86360 – Absolute CD4, CD8 and Ratio 86361 – Absolute CD4 count 3500F – CD4+ cell count or percentage* –Also take the values and dates for these tests Take Note: Electronic CD4 counts can also help you to identify counts below 200, so you can more easily find the patients who needs PCP Prophylaxis

13. 13 Clinical Information- PCP Prophylaxis Q 51. PCP Prophylaxis –Look first for patients with the ICD code of 042 who had visits during the reporting period –Then look for a viral load count < 200 –Then look in your billing system for prophylactic prescriptions for: Atovaquone Bactrim Dapsone Pentamdine

14. 14 Clinical Information- Syphilis Screening Q 55. Has the client been screened for Syphilis –Look in your billing system for these codes: 36415 – Venipuncture 86592 – Syphilis Test, qualitative 86781 – Antibody, treponimal pallidum, confirmatory 87164 – Dark Field Examination, with specimen 87166 – Dark Field Examination, without specimen –Also take the dates for the screening tests

15. 15 Clinical Information- Substance Abuse Q 61. Was the client screened for substance abuse (alcohol or drugs) –Look in your billing system for these codes: 99210 to 99215 - Evaluation & Management 99408 to 99409 - Assessment and Brief Intervention for Alcohol and/or Drug Abuse - GO396 & GO397 (Medicare); HO049 & HO050 (Medicaid) –Also take the dates for these screens

16. 16 Clinical Information- Mental Health Q 62. Was a mental health screening conducted for the client –Look in your billing system for these codes: 99210 to 99215 - Evaluation & Management 95150 to 96155 - Health Behavioral Assessment and Intervention –Also take the values and dates for these tests

17. 17 Clinical Information- ART in Pregnancy Q 66. For HIV+ women only: was the client prescribed Antiretroviral Therapy (ART) during Pregnancy –Look in your billing system for this code: 4271F – Patient receiving potent ART for less than 6 months or not receiving potent ART –Also take the dates for the ART visits

18. 18 Clinical Information- National Drug Codes -Bactrim Bactrim, the brand name, or Septra, is an antibacterial drug covered by the AIDS Drug Assistance Program (ADAP) There are a number of discrete NDC codes, reflecting different delivery and dosage strengths –Look in your billing system for Bactrim’s therapeutic class code: 00472128516, or, for specific prescriptions –Bactrim Oral Suspension 200-40MG: 00472128516 –Bactrim Tablet 400MG-80MG: 00093008801

19. 19 RSR TA and Data Resources Reminder: http://careacttarget.org/rsr.asp Email address for RSR questions: Data.TA@cicatelli.org Today’s Q & A

20. 20 RSR TA and data Resources