CHAPTER 153
HEALTH CARE INFORMATION
153.05 Collection and dissemination of health care and related information.
153.07 Board powers and duties.
153.08 Hospital rate increases or charges in excess of rates.
153.10 Health care data reports.
153.15 Small area analysis reports.
153.20 Uncompensated health care services report.
153.25 Mortality and morbidity report.
153.30 Health care insurance report.
153.35 Report by the office.
153.40 Procedures for data verification and review.
153.50 Protection of patient confidentiality.
153.60 Assessments to fund operations of office and board.
153.65 Provision of special information; user fees.
153.01
153.01
Definitions. In this chapter:
153.01(2)
(2) "Board" means the board on health care information.
153.01(3)
(3) "Charge element" means any service, supply or combination of services or supplies that is specified in the categories for payment under the charge revenue code for the uniform billing form HCFA-1450.
153.01(4m)
(4m) "Commissioner" means the commissioner of insurance of this state.
153.01(6)
(6) "Office" means the office of health care information.
153.01(7)
(7) "Patient" means a person who receives health care services from a health care provider.
153.01(8)
(8) "Payer" means a 3rd party payer, including an insurer, federal, state or local government or another who is responsible for payment of a hospital charge.
153.01(9)
(9) "Uniform patient billing form" means, for a hospital, the uniform billing form HCFA-1450 developed by the national uniform billing committee, or the equivalent electronic billing format, or, for an ambulatory surgery center or noninstitutional or outpatient health care provider, the health insurance claim form HCFA-1500 or the equivalent electronic billing format.
153.01 History
History: 1987 a. 399;
1993 a. 16,
185,
491.
153.05
153.05
Collection and dissemination of health care and related information. 153.05(1)
(1) In order to provide to hospitals, health care providers, insurers, consumers, governmental agencies and others information concerning hospital service utilization, charges, revenues, expenditures, mortality and morbidity rates and uncompensated health care services, and in order to provide information to assist in peer review for the purpose of quality assurance, the office shall collect, analyze and disseminate, in language that is understandable to lay persons, health care information obtained from the following data sources:
153.05(1)(c)
(c) Hospital reports that include all of the following:
153.05(1)(c)1.
1. Identification of charges in each hospital's most recent entire fiscal year for up to 100 charge elements, as selected by the office, and identification of the increase or decrease in charges for each of these charge elements from amounts charged during the hospital's entire fiscal year that is nearest in time to the hospital's most recent entire fiscal year.
153.05(1)(c)2.
2. The dollar amount of total gross and net revenue increases or decreases from each hospital's most recent entire fiscal year.
153.05(1)(c)3.
3. The dollar amount of gross and net revenue increases or decreases from each hospital's most recent entire fiscal year that is attributable to the sum of increases or decreases in all charge elements.
153.05(1)(d)
(d) Hospital-specific uncompensated health care services reports, plans and projections.
153.05(1)(e)
(e) Final audited financial statements of hospitals that include, for a hospital's most recent entire fiscal year, as dollar amounts, the amounts of revenue and expenditures for the hospital, in categories specified in rules promulgated by the commissioner.
153.05(2)
(2) The office shall provide copies of reports published under
ss. 153.10 to
153.35 at no charge to hospitals assessed under
s. 153.60 (1) and, if assessed, at no charge to ambulatory surgery centers assessed under
s. 153.60 (2). The office shall provide copies of the reports to any person, upon the person's request, and the board shall advise the office as to whether the copies shall be provided at no charge or at a charge not to exceed the cost of printing, copying and mailing the report to the person.
153.05(3)
(3) Upon request of the office, state agencies shall provide health care information to the office for use in preparing reports under
ss. 153.10 to
153.35.
153.05(4)(a)(a) The office, under rules promulgated by the commissioner, shall require hospitals to use, and private-pay patients and payers who are insurers to accept, uniform patient billing forms, shall require hospitals to submit to the office the information provided on the billing forms, including, for an injury, the external cause of the event, and may require payers who are insurers to use a standard set of definitions for base data reporting under a uniform patient billing form.
153.05(4)(b)
(b) The office, under rules promulgated by the commissioner, may require ambulatory surgery centers to use uniform patient billing forms and other information, and, if so requiring, shall require ambulatory surgery centers to submit to the office the information provided on the billing forms, including, for an injury, the external cause of the event, using a standard set of definitions for base data reporting.
153.05(5)(a)
(a) Shall require hospitals to submit information regarding medical malpractice, staffing levels and patient case-mix, and expenditures related to labor relations consultants, as specified by the office.
153.05(5)(b)
(b) May require hospitals to submit to the office information from sources identified under
sub. (1) (a) to
(e) that the office deems necessary for the preparation of reports, plans and recommendations under
ss. 153.10 to
153.35 and any other reports required of the office in the form specified by the office.
153.05(5)(bm)
(bm) Shall require a hospital to submit to the office information from sources identified under
sub. (1) (e) by the date that is 4 months following the close of the hospital's fiscal year unless the office grants an extension of time to file the information.
153.05(6)
(6) If the requirements of
s. 153.07 (2) are first met, the office may contract with a public or private entity that is not a major purchaser, payer or provider of health care services in this state for the provision of data processing services for the collection, analysis and dissemination of health care information under
sub. (1) or the department of health and family services shall provide the services under
s. 153.07 (2).
153.05(6m)
(6m) If the requirements of
s. 153.07 (2) are first met, the office may contract with the group insurance board for the provision of data collection and analysis services related to health maintenance organizations and insurance companies that provide health insurance for state employes or the commissioner shall provide the services under
s. 153.07 (2). The office shall establish contract fees for the provision of the services. All moneys collected under this subsection shall be credited to the appropriation under
s. 20.145 (8) (kx).
153.05(7)
(7) The office may require each insurer authorized to write disability insurance to submit to the office information obtained on uniform patient billing forms regarding reported claims for health care services which insureds who are residents of this state obtain in another state.
153.05(8)
(8) Beginning April 1, 1992, the office shall collect, analyze and disseminate, in language that is understandable to lay persons, health care information under the provisions of this chapter, as determined by rules promulgated by the commissioner, from health care providers, as defined by rules promulgated by the commissioner, other than hospitals and ambulatory surgery centers. Data from physicians shall be obtained through sampling techniques in lieu of collection of data on all patient encounters and data collection procedures shall minimize unnecessary duplication and administrative burdens.
153.05(9)
(9) The office shall provide orientation and training to physicians, hospital personnel and other health care providers to explain the process of data collection and analysis and the procedures for data verification, interpretation and release.
153.05(11)
(11) In order to elicit public comment concerning the reports required under
ss. 153.10 to
153.35, the office shall, following the release of the reports and by a date that is determined by the board provide notice of and hold public hearings.
153.05(12)
(12) The office shall, to the extent possible and upon request, assist members of the public in interpreting data in health care information disseminated by the office.
