DHS 120.12(2)(b)1.a.
a. Gross revenue the hospital derives from services it provides to patients and the sources of that revenue.
DHS 120.12(2)(b)1.b.
b. Deductions from gross revenue the hospital derives from services it provides to patients and the sources of that revenue, including contractual adjustments, charity care and other noncontractual deductions.
DHS 120.12(2)(b)1.q.
q. The dollar difference between gross and net revenue figures for the current and previous fiscal years.
DHS 120.12(2)(b)1.r.
r. The amount of the dollar difference between gross and net revenue figures attributable to a price change, the amount attributable to a utilization change and the amount attributable to any other cause for the current and previous fiscal years.
DHS 120.12(2)(b)2.
2. `Prior year hospital uncompensated care charge data.' The number of patients obtaining uncompensated health care services from the hospital in its most recently completed fiscal year, and the total accrued charges for those services, as determined by all of the following:
DHS 120.12(2)(b)2.a.
a. The number of patients whose accrued charges were attributed to charity care in that fiscal year.
DHS 120.12(2)(b)2.b.
b. The total accrued charges for charity care, based on revenue foregone at full established rates, in that fiscal year.
DHS 120.12(2)(b)2.c.
c. The number of patients whose accrued charges were determined to be a bad debt expense in that fiscal year.
DHS 120.12(2)(b)2.d.
d. The total bad debt expense, as obtained from the hospital's final audited financial statements in that fiscal year.
DHS 120.12(2)(b)3.
3. `Anticipated hospital uncompensated care charge data.' The projected number of patients anticipated to obtain uncompensated health care services from the hospital in its ensuing fiscal year, and the projected charges for those services, as determined by all of the following:
DHS 120.12(2)(b)3.a.
a. The hospital's projected number of patients anticipated to obtain charity care for that fiscal year.
DHS 120.12(2)(b)3.b.
b. The hospital's projected total charges attributed to charity care for that fiscal year.
DHS 120.12(2)(b)3.c.
c. The hospital's projected number of patients anticipated to incur bad debt expenses.
DHS 120.12(2)(b)3.e.
e. A rationale for the hospital's projections under subdpars. a. to d., considering the hospital's total patients and total accrued charges for the most recently completed fiscal year.
DHS 120.12(2)(b)4.
4. `Hospital uncompensated care obligation data.' If the hospital has a current obligation or obligations under
42 CFR Part 124, the hospital shall report the date or dates the obligation or obligations went into effect, the amount of the total federal assistance believed to be under obligation at the hospital and the date or dates the obligation or obligations will be satisfied.
DHS 120.12(2)(b)5.a.a. Each hospital shall submit to the department an extract of the data requested by the department from its final audited financial statements. If the data requested by the department do not appear on the audited financial statements, the hospital shall gather the data from medicare cost reports, notes to the financial statements or other internal hospital financial records. A hospital need not alter the way it otherwise records its financial data in order to comply with this subdivision.
DHS 120.12(2)(b)5.b.
b. If a hospital is jointly operated in connection with a nursing home, a home health agency or other organization, the hospital shall submit the data specified under
subd. 1. a. to
k. for the hospital unit only.
DHS 120.12(2)(b)5.c.
c. If a hospital is jointly operated in connection with a nursing home, a home health agency or other organization, the hospital shall submit the data specified under
subd. 1. L. to
m. for the hospital unit only. If the hospital unit data cannot be separated from the total facility data, the hospital shall report the data for the total facility.
DHS 120.12(2)(b)5.d.
d. County-owned psychiatric or alcohol and other drug abuse hospitals are not required to submit any data specified under
subd. 1. L. to
m.
DHS 120.12(2)(b)6.a.a. A mental health institute shall submit to the department an extract of the data requested by the department for a specific fiscal year from the mental health institute's audited or unaudited financial statements. If the audit report is not yet available, the mental health institute may provide unaudited financial statements. If the data requested do not appear on the financial statements, the mental health institute shall gather the data from medicare cost reports, notes to the financial statements or other internal mental health institute financial records.
DHS 120.12(2)(b)6.b.
b. A mental health institute shall submit at least the dollar amounts for the items under
subd. 1. a. through
k. that are available from the state fiscal system.
DHS 120.12(2)(c)1.1. A hospital shall submit to the department, no later than 120 calendar days following the close of the hospital's fiscal year, the dollar amounts of the financial data, as specified in
par. (b).
DHS 120.12 Note
Note: Health care providers who are required to send their information directly to the department should use the following address: Bureau of Health Information and Policy, P. O. Box 2659, Madison, Wisconsin 53701-2659, or deliver the communications to Room 372, 1 W. Wilson Street, Madison, Wisconsin.
DHS 120.12(2)(c)2.a.a. Except as provided in
subd. 2. b., the department may grant an extension of a deadline specified in
subd. 1. only when the hospital adequately justifies to the department the hospital's need for additional time. In this subdivision, “adequate justification" means a delay due to a strike, fire, natural disaster or catastrophic computer failure. A hospital desiring an extension shall submit a request in writing to the department at least 10 calendar days prior to the date that the data are due. The department may grant an extension for up to 30 calendar days.
DHS 120.12(2)(c)2.b.
b. The department may extend the deadline specified in
subd. 1. for a mental health institute for up to 90 calendar days upon written request.
DHS 120.12(2)(d)1.1. Each hospital shall review the data for accuracy and completeness prior to submitting data to the department.
DHS 120.12(2)(d)2.
2. The department shall check the accuracy and completeness of all submitted financial data.
DHS 120.12(2)(d)3.
3. The department shall notify a hospital if any of the data appear questionable.
DHS 120.12(2)(d)4.
4. The hospital shall either verify the accuracy of the data or submit to the department corrected data within 10 working days from the date the department notified the hospital of the questionable data.
DHS 120.12(2)(d)5.
5. After the department has made any revisions under
subd. 4. in the data for a particular hospital, the department shall send to the hospital a copy of all data variables submitted by that hospital to the department or subsequently corrected by the department.
DHS 120.12(2)(d)6.
6. Within the 10 working days specified in
subd. 4., the hospital shall review the data for accuracy and completeness and shall supply the department any corrections to the data.
DHS 120.12(2)(d)7.a.a. Within the same 10-working day period under
subd. 6., the chief executive officer or designee of each hospital shall submit to the department a signed affirmation statement.
DHS 120.12(2)(d)7.b.
b. Hospitals submitting affirmation statements to the department electronically shall use a digital signature approved by the department and returned by the hospital during the timeframes for data submission specified by the department. A signature on the electronic data affirmation statement represents the signatory's acknowledgment that the data is accurate and the data submitter may no longer submit revised data.
DHS 120.12(2)(d)7.c.
c. If the department discovers data errors after the department's release of the data or if a hospital representative notifies the department of data errors after the department's release of the data, the department shall note the data errors as caveats to the completed datasets.
DHS 120.12(2)(e)
(e)
Data adjustment methods. There shall be no adjustment methods for final audited financial statement data submitted by hospitals.
DHS 120.12(2)(f)1.1. There shall be no waivers from the data submission requirements under this subsection.
DHS 120.12(2)(f)2.
2. Hospitals that close, merge or change their reporting fiscal year shall submit a partial final audited financial statement for the applicable partial year.
DHS 120.12(3)(b)
(b)
Data to be collected. Hospitals shall submit to the department, in the format specified by the department, the following data:
DHS 120.12(3)(b)2.
2. Type of service that best describes the services the hospital provides.
DHS 120.12(3)(b)4.
4. Existence of contracts with prepaid health plans, including health maintenance organizations, and other alternative health care payment systems.
DHS 120.12(3)(b)8.
8. Number of beds and inpatient utilization for the total facility, including beds set up and staffed, admissions, discharges and days of care.
DHS 120.12(3)(b)11.
11. Swing-bed utilization, if applicable, including average number of swing beds, discharges and days of care.
DHS 120.12(3)(b)12.
12. Use of nursing home services, if applicable, including beds set up and staffed, discharges and days of care.
DHS 120.12(3)(b)13.
13. Medical staff information, including availability of contractual arrangements with physicians in a paid capacity, total number of active or associate medical staff by selected specialty and number of board certified medical staff by selected specialty, if applicable.
DHS 120.12(3)(b)14.
14. Number of personnel on the hospital's payroll, including hospital personnel, trainees and nursing home personnel by occupational category and by full-time or part-time status.
DHS 120.12(3)(c)1.1. A hospital shall submit to the department the data specified in
par. (b) according to a schedule specified by the department.
DHS 120.12 Note
Note: Health care providers who are required to send their information directly to the department should use the following address: Bureau of Health Information and Policy, P. O. Box 2659, Madison, Wisconsin 53701-2659, or deliver the communications to Room 372, 1 W. Wilson Street, Madison, Wisconsin.
DHS 120.12(3)(c)2.
2. The department may change the due date specified in
subd. 1. and if the department does so, the department shall notify each hospital of the change at least 30 days before the data are due.
DHS 120.12(3)(c)3.
3. The department may grant an extension of a deadline specified in this paragraph only when the hospital adequately justifies to the department the hospital's need for additional time. In this subdivision, “adequate justification" means a delay due to a strike, fire, natural disaster or catastrophic computer failure. A hospital desiring an extension shall submit a request for an extension in writing to the department at least 10 calendar days prior to the date that the data are due. The department may grant an extension for up to 30 calendar days.
DHS 120.12(3)(d)1.1. Each hospital shall review the data for accuracy and completeness prior to submitting the survey to the department.
DHS 120.12(3)(d)2.
2. The department shall check the accuracy and completeness of all submitted information.
DHS 120.12(3)(d)3.
3. If the department has contacted the hospital and has determined that resubmission of the survey is necessary, the department shall return questionable survey response data to the hospital that submitted the survey with information for revision and resubmission.
DHS 120.12(3)(d)4.
4. The hospital shall resubmit the survey returned by the department to the hospital within 10 working days after the hospital's receipt of the questionable survey.
