Provider-Preventable Conditions - Reporting
Back to PPC FAQ Home Page
Is reporting mandatory?
When must I report a PPC?
Providers must report a PPC after discovery and confirmation that the patient is a Medi-Cal beneficiary.
When is "discovery?" What if the PPC was discovered after the patient was discharged?
"Discovery" refers to when a provider first learns that a patient had a PPC and confirms that the patient is a Medi-Cal beneficiary. DHCS understands that discovery might be after the patient has been discharged, including discovery during coding and billing.
Do I need to report a PPC for a patient whose Medi-Cal approval is pending?
If the patient’s Medi-Cal eligibility was pending at the time of discovery, the provider should report the PPC after confirming Medi-Cal eligibility.
How do providers report a PPC?
Providers should report PPCs by filling out the form using the
secure online portal on the DHCS PPC webpage. The reports are then entered into a secure database.
How do providers in managed care plans (MCP) report PPCs?
Providers who work for a MCP should use the
secure online portal and notify the patient’s MCP about the PPC. Please see
All Plan Letter 17-009 for more information about reporting requirements for managed care plans. The online portal will allow providers to print their report after they submit the report if they also need to send a copy of the report to the MCP.
If I report an adverse event or a
healthcare-associated infection (HAI) to the California Department of Public Health (CDPH), as required by state law, do I still need to report the same PPC to DHCS?
Yes. Providers need to report to both departments if the patient is a Medi-Cal beneficiary and the condition meets the reporting requirements for CDPH. The reporting requirements for PPCs are different than those for adverse events and HAIs to CDPH. The differences in reporting requirements include 1) the type of events providers must report, 2) the severity of the events reported, 3) the consequences of the events, and 4) the timeframe for reporting HAIs to CDPH.
If my patient already had a PPC when I began treating him/her, do I still need to report it?
No. Providers should not report a PPC that existed prior to the initiation of treatment by that provider.
What is the threshold of severity for when I need to report a PPC?
Providers need to report all PPCs that are associated with claims for Medi-Cal payment or with courses of treatment given to a Medi-Cal patient for which payment would otherwise be available.
Do Long-Term Care (LTC) facilities need to report PPCs?
LTC facilities need only report
OPPCs.
LTC facilities include the following:
• Freestanding skilled nursing facilities
• Freestanding or distinct part intermediate care facilities
• Intermediate care facilities/developmentally disabled – habilitative
• Intermediate care facility/developmentally disabled
• Intermediate care facility/developmentally disabled – nursing
• Freestanding and distinct part subacute facilities (adult and pediatric)
• Distinct part skilled nursing facilities
LTC facilities must also report OPPCs that occur during the delivery of services reimbursed via the following: rural swing beds, hospice services, bed hold days, special treatment programs, and administrative day rates.
My facility has both acute inpatient hospital units and skilled nursing facility (SNF) units. Which PPCs am I required to report?
Inpatient acute care hospitals must report all
HCACs and
OPPCs, while all other facilities only report OPPCs
If a facility has both acute inpatient care hospital units and SNF units, the facility should use bed licensing to determine reporting requirements for each unit.
What is the process for reporting PPCs for California Children’s Services’ (CCS) patients?
Do the PPC reporting requirements and payment adjustment apply to out-of-state providers for Medi-Cal beneficiaries?
Yes.
What does DHCS do with reports of PPCs?
DHCS uses PPC reports to determine if a payment adjustment is appropriate. DHCS abides by Health Insurance Portability and Accountability Act (HIPAA) requirements for confidentiality and will also evaluate the data of reported PPCs to develop quality improvement programs.
How do we retract a report we already submitted if we entered incorrect information or later determine that it did not meet the criteria for reporting?
If you believe that you should not have reported a PPC or submitted a report with a mistake, please send the information about the event and the correction or why you believe it should not have been reported to
PPCHCAC@dhcs.ca.gov and keep a copy of the email for your records. A&I will match up concerns for fee-for-service providers with the previously submitted reports for its review and have a record of your request to retract or correct the report when it conducts an audit.
