Register February 2012 No. 674
Chapter DHS 120
HEALTH CARE INFORMATION
Subchapter I — General Provisions
Authority and purpose.
Subchapter II — Administration
Assessments to fund the ch. 153
, Stats., operations of the department and the board.
Communications addressed to the department.
Selection of a contractor.
Reporting status changes required.
Notice of hospital rate increases or charges in excess of rates.
Subchapter III — Data Collection and Submission
Common data verification, review and comment procedures.
Data to be submitted by hospitals.
Data to be submitted by freestanding ambulatory surgery centers.
Data to be submitted by physician class of provider.
Data to be submitted by other classes of health care providers.
Data to be submitted by health care plans.
Subchapter IV — Standard Reports
Guide to Wisconsin hospitals.
Utilization, charge and quality reports.
Hospital rate increase report.
Uncompensated health care services report.
Hospital quality indicators report.
Subchapter V — Data Dissemination
Public use files.
Patient data elements considered patient-identifiable.
Ch. DHS 120 Note
Chapter HSS 120 was renumbered ch. Ins 120, Register, February, 1995, No. 470
, eff. 3-1-95. Corrections made under s. 13.93 (2m) (b) 6. and 7., Stats., Register, June, 1997, No. 498
. Chapter Ins 120 was renumbered Chapter HFS 120 under s. 13.93 (2m) (b) 1., Stats., and corrections made under s. 13.93 (2m) (b) 6. and 7., Stats., Register, January, 1998, No. 505
. Chapter HFS 120 was repealed and recreated, Register, December, 2000, No. 540
, eff. 1-1-01. Chapter HFS 120 was renumbered to chapter DHS 120 under s. 13.92 (4) (b) 1., Stats., and corrections made under s. 13.92 (4) (b) 7, Stats., Register January 2009 No. 637
DHS 120.01 Authority and purpose.
This chapter is promulgated under the authority of s. 153.75
, Stats., to implement ch. 153, Stats.
Its purpose is to provide to health care providers, insurers, consumers, governmental agencies and others information concerning health care providers and uncompensated health care services, and provide information to assist in peer review for the purpose of quality assurance.
DHS 120.01 History
Cr. Register, December, 2000, No. 540
, eff. 1-1-01.
DHS 120.02 Applicability.
This chapter applies to the department, the board on health care information, the independent review board, qualified vendors, health care plans, health care providers licensed in this state and persons requesting data from the department.
DHS 120.03 Definitions.
Unless otherwise indicated, in this chapter:
“Affirmation statement" means a department document that when signed by a health care provider or an authorized representative of a health care provider submitting data to the department affirms, to the best of the signer's knowledge, all of the following:
Any necessary corrections to data submitted to the department have been made.
“Bad debts" means claims arising from rendering patient care services that the hospital, using a sound credit and collection policy, determines are uncollectible, but does not include charity care.
“Board" means the board on health care information established under s. 15.195 (6)
“Charity care" means health care a hospital provides to a patient who, after an investigation of the circumstances surrounding the patient's ability to pay, including nonqualification for a public program, is determined by the hospital to be unable to pay all or a portion of the hospital's normal billed charges. “Charity care" does not include any of the following:
Care provided to patients for which a public program or public or private grant funds pay for any of the charges for the care.
Contractual adjustments in the provision of health care services below normal billed charges.
Differences between a hospital's charges and payments received for health care services provided to the hospital's employees, to public employees or to prisoners.
Hospital charges associated with health care services for which a hospital reduces normal billed charges as a courtesy.
“Contractual adjustment" means the difference between a hospital's full amount billed for medical services for patient services and the discounted charge or payment received by the hospital from the payer.
“Data profile" means a summary of all submitted data and a summary of the number of records received by the department from a health care provider.
“Data submission manual" means the department's document specifying the procedures for submitting data, including data formats, coding specifications and instructions for editing incorrect data.
“Data summary" means a report summarizing what the health care provider submitted, including number of records, and a listing of all questionable data records.
“Department" means the department of health services.