J-24 Examples of Reports.pdf

J.18 - Examples of Reports

In the list below, reports that are marked with an asterisk are already included in the current Quarterly Report but are included in this list to have a complete compendium of reporting needs.

Monitoring Exam Reports

M-1. Number of responders completing Monitoring Exams *

This report gives the number of responders completing monitoring exams on a quarterly basis with a total for the most recent four quarters. The number of exams completed is broken out by the number of responders completing their Initial Exam, 2nd Exam, 3rd Exam, etc. The report also includes the total number of responders who have ever had Exam 1, 2, 3, etc. in the WTC Program since Federal funding began.

M-2. Monitoring Exam Financial Report

This report gives the cost of conducting monitoring exams. Each cost element of the exam is defined, such as the medical history interview, lab work, PFT, chest X-ray (if applicable), and the physical exam, and the average cost of each element is calculated from the information collected on each exam. The information should include the responder ID, the provider, the location of the service, and the date of service.

Costs associated with scheduling the exam, performing quality assessments on the PFT tests, and summarizing the results of the interview, tests, and prior monitoring exams for the physical exam provider are considered administrative costs. These administrative costs should be included on the Administrative Financial Report.

M-3. Number of responders referred from the Monitoring Exam for further diagnosis for each WTC covered condition

This report lists the number of responders referred from a Monitoring Exam for further diagnosis for each WTC covered condition. (If a responder receives a referral for further diagnosis for more than one WTC covered condition, the responder will be counted in each category.) This information should be reported on a quarterly basis with a rolling total for the previous four quarters. The report should include the responder ID, the provider making the referral, the date of referral, and the WTC covered condition(s)

(ICD9).

M-4. Number of responders referred from the Monitoring Exam for treatment for each WTC covered condition

This report lists the number of responders referred from a Monitoring Exam for treatment for each WTC covered condition. (If a responder receives a referral for treatment for more than one WTC covered condition, the responder will be counted in each category.) This information should be reported on a quarterly basis with a rolling total for the previous four quarters. The report should include the responder ID, the provider making the referral, the date of referral, and the WTC covered condition(s)

M-5. Number of responders referred from the Monitoring Exam for further diagnosis for each non-WTC covered condition

This report lists the number of responders referred from a Monitoring Exam for further diagnosis for each non-WTC covered condition. (If a responder receives a referral for further diagnosis for more than one non-WTC covered condition, the responder will be counted in each category.) This information should be reported on a quarterly basis with a rolling total for the previous four quarters. The report should include the responder ID, the provider making the referral, the date of referral, and the non-WTC covered condition(s) (ICD9).

M-6. Number of responders referred from the Monitoring Exam for further diagnosis for each non-WTC covered condition

This report lists the number of responders referred from a Monitoring Exam for treatment for each non-WTC covered condition. (If a responder receives a referral for treatment for more than one non-WTC covered condition, the responder will be counted in each category.) This information should be reported on a quarterly basis with a rolling total for the previous four quarters. The report should include the responder ID, the provider making the referral, the date of referral, and the non-WTC covered condition(s)

M-7. Classification of responders completing Monitoring Exam

This report lists the number of responders in each status category who complete a Monitoring Exam. Status Categories currently include former FDNY employees, Federal employees, and New Transfers. Additional Status Categories may be added in the future. This information should be reported on a quarterly basis with a rolling total for the previous four quarters.

M-8. Gender of responders completing Monitoring Exam

This report lists the number of responders, by gender, who complete a Monitoring Exam. This information should be reported on a quarterly basis with a rolling total for the

M-9. Age of responders completing Monitoring Exam

This report lists the number of responders, by age group, who complete a Monitoring Exam. This information should be reported on a quarterly basis with a rolling total for the

M-10. Employment status of responders completing Monitoring Exam

This report lists the number of responders in each employment status category who complete a Monitoring Exam. Employment Status Categories currently include Currently Employed, Unemployed/Laid Off, Extended Sick Leave/Disability, Retired, Other, and Not Recorded. Additional Employment Status Categories may be added in the future.

This information should be reported on a quarterly basis with a rolling total for the

M-11. Current occupation of responders completing Monitoring Exam

This report lists the number of responders in each occupation category who complete a Monitoring Exam. Occupation Categories currently include Construction, Law Enforcement, Civilian Public Sector, Technical and Utilities, Transportation, Cleaning/Maintenance, Volunteer, Firefighter (excludes FDNY), Healthcare, News Agency, Office/Administration/Professional, Federal Employee, Other, Not Currently Employed, and Not Recorded. Additional Occupation Status Categories may be added in the future. This information should be reported on a quarterly basis with a rolling total for the previous four quarters.

M-12. Insurance status of responders completing Monitoring Exam

This report lists the number of responders who either have or do not have health insurance outside of the WTC Program. This information should be reported on a quarterly basis with a rolling total for the previous four quarters.

M-13. Insurance category of responders completing Monitoring Exam

This report lists the number of responders in each insurance category who complete a Monitoring Exam. Insurance Categories currently include Aetna, Blue Cross/Blue Shield, GHI, HIP, Other Managed care/PPO, Other Managed Care/HMO, Other Private, Medicaid, Medicare, No Third Party Coverage, and Declined Information. Additional Insurance Categories may be added in the future. This information should be reported on a quarterly basis with a rolling total for the previous four quarters.

M-14. Workers’ Compensation status of responders completing Monitoring Exam

This report lists the number of responders in each Workers’ Compensation category who complete a Monitoring Exam. Workers’ Compensation Categories currently include Patient is not covered by NYS WC, WC claim filed by Healthcare Provider, WC claim controverted, WC claim established, settled, or closed and medical care authorized, WC claim established, settled, or closed and medical care NOT authorized, and WC claim status unknown. Additional Workers’ Compensation Categories may be added in the future. This information should be reported on a quarterly basis with a rolling total for the

M-15. Line of Duty status of responders completing Monitoring Exam

This report lists the number of responders in each Line of Duty category who complete a Monitoring Exam. Line of Duty Categories currently include Patient is not covered by LODI, LODI claim filed, and LODI claim established. Additional Line of Duty Categories may be added in the future. This information should be reported on a quarterly basis with a rolling total for the previous four quarters.

M-16. Location of responders receiving Monitoring Exam

This report lists the number of responders, by location, who complete a Monitoring Exam. For this report, location is based on the Zip Code of the current residence of the responder. The report should include the Responder’s ID, the Responder’s Zip Code of residence, the Provider’s ID, the Provider’s Zip Code, and the date of service. This information should be reported on a quarterly basis with a rolling total for the previous four quarters.

M-17. Name and location of providers for each portion of the Monitoring Exam

This report lists the number of responders, by location, who complete each portion of a Monitoring Exam. For this report, location is based on the Zip Code of the healthcare provider of each portion of the Monitoring Exam including the Medical History Questionnaire, lab work, PFT, Chest X-ray, and physical examination. The report should include the Responder’s ID, the Responder’s Zip Code of residence, the Provider’s ID, the Provider’s Zip Code, and the date of service. This information should be reported on a quarterly basis with a rolling total for the previous four quarters.

M-18. Monitoring Exam “No Show” Report

This report lists the number of responders who fail to complete a scheduled appointment. The report should include the Responder’s ID, the Responder’s Zip Code of residence, the Provider’s ID, the Provider’s Zip Code, and the date of service, the type of appointment missed (ie lab work, PFT, physical examination), and the number of previous appointments that the responder has missed. This information should be reported on a quarterly basis with a rolling total for the previous four quarters.

M-19. Monitoring Exam Irregularity Report

This report lists any irregularities in the Monitoring Exam process reported by the provider. This report should include the responder ID, the provider ID, the service date, he details of the irregularity, and any actions taken as a result of the irregularity.

Treatment Reports

T-1. Number of responders currently in Treatment

This report lists the number of responders who are currently receiving treatment services. Treatment services are defined as an encounter with a healthcare provider for treatment of a WTC covered condition or receipt of an approved medication to treat a WTC covered condition. This report should include the number of responders receiving treatment encounters only, the number of responders receiving medications only, and the number of responders receiving treatment encounters and medications. The report should also designate if the purpose of the treatment encounter is diagnostic (to confirm a WTC covered condition) or to treat a WTC covered condition. This information should be reported on a quarterly basis with a rolling total of unique responders for the previous

T-2. Treatment Encounter Report

This report lists the details of each treatment encounter. The treatment encounter may include providing an approved service to treat a WTC covered condition or a diagnostic procedure to confirm a WTC covered condition.

Treatment Encounter details should be reported on a quarterly basis with a rolling total for the previous four quarters. The report should include the responder ID, the provider ID, the location of the service, the date of service, the ICD9 code of the primary covered condition being treated, the ICD9 code of the secondary condition (if applicable), the CPT or other codes associated with the treatment encounter, and the cost of each service provided.

T-3. Medication Report

This report lists the details of each medication prescribed to treat a WTC covered condition.

Medication details should be reported on a quarterly basis with a rolling total for the previous four quarters. The report should include the responder ID, the provider ID, the location of the service, the date of service, the ICD9 code of the primary covered condition being treated, the ICD9 code of the secondary condition (if applicable), the name of the medication, dosage information, and the cost of each medication prescribed.

T-4. Case Management Report

This report lists the number of responders receiving case management services and the level of case management services being provided. In addition to the numbers of responders in case management, the report should also include a narrative which summarizes the health status of the responder. The number of responders in case management should be reported on a quarterly basis with a rolling total for the previous

T-5. Health Condition Report

This report lists the number of responders who have been diagnosed with a WTC covered condition or conditions. The report should be able to be produced for each WTC covered condition (ICD9). For reporting purposes, several ICD9 codes may be grouped into condition categories. Currently, condition categories include Upper Airway, Lower Airway, Gastrointestinal, Musculoskeletal, and Mental Health. Different groupings of ICD9 codes may be requested in the future. The number of responders in each condition category should be reported on a quarterly basis with a rolling total of unique responders for the previous four quarters. The report should also include the number of responders diagnosed with a physical condition only, those with a mental health condition only, and those with both a physical and mental health condition.

T-6. Medical Appeals Report

This report lists the number of responders who have filed a formal medical appeal. The report should include the Responder ID, the nature of the appeal, and the status of the appeal. The number of medical appeals should be reported on a quarterly basis with a rolling total for the previous four quarters.

T-7. Hospitalization Report

This report lists the number of responders who have been hospitalized (inpatient) for a WTC covered condition. The report should include the WTC covered condition for which the responder is hospitalized, the duration of the hospitalization, and all costs associated with the hospitalization. The number of hospitalizations should be reported on a quarterly basis with a rolling total for the previous four quarters.

T-8. Comorbidity Report

This report lists the number of responders who have been diagnosed with a condition on the WTC Comorbidity List. The WTC Comorbidity List includes health conditions that are not covered under the WTC Program but are being tracked to get a better understanding of the overall health of the responder population. The report should list the number of unique responders in each of the following comorbidity classes: Cardiac, Musculoskeletal, Endocrine/Renal/GI, Cancer, and Other. The number of responders with each comorbidity class should be reported on a quarterly basis with a rolling total for the previous four quarters.

T-9. Treatment Encounter “No Show” Report

This report lists the number of responders who fail to complete a scheduled treatment appointment. The report should include the Responder’s ID, the Responder’s Zip Code of residence, the Provider’s ID, the Provider’s Zip Code, and the date of service, the type of appointment missed (ie diagnostic, treatment), and the number of previous appointments that the responder has missed. This information should be reported on a quarterly basis with a rolling total for the previous four quarters.

T-10. Treatment Irregularity Report

This report lists any irregularities in the treatment process reported by the provider.

This report should include the responder ID, the provider ID, the service date, he details of the irregularity, and any actions taken as a result of the irregularity.

Administrative Reports

A-1. Responder Status Report

The Responder Status Report lists the total number of responders for whom the reporting entity is responsible. These responders should be categorized as Participating in the Program, Eligibility Pending, Ineligible, Refused, Unable to Contact, Deceased, and Transferred. This information should be reported on a quarterly basis with a rolling total for the previous four quarters.

A-2. Administrative Financial Report

This report should include the cost associated with each type of administrative service provided. Examples of administrative services include project management, case management, social service referrals, Workers’ Compensation assistance, data entry, etc. This information should be reported on a quarterly basis with a rolling total for the