Section DHS 120.12 - Data to be submitted by hospitals(1) UNCOMPENSATED HEALTH CARE PLAN.(a)Data to be collected. Hospitals shall provide all of the following data: 1. A set of definitions describing terms used by the hospital throughout the uncompensated health care plan.2. The procedures the hospital uses to determine a patient's ability to pay for health care services received and to verify financial information from the patient.3. The hospital's means of informing the public about charity care available at that hospital and a description of the procedure for obtaining the care.4. The amount of any state loan funds, excluding fund proceeds from the Wisconsin health and educational facilities authority, outstanding with a continuing obligation during the previous year.(b)Data submission procedures.1. Every hospital shall annually file with the department within 120 calendar days following the close of the hospital's fiscal year the plan required under par. (a). 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.
2. The department may grant an extension of a deadline specified under 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 delay due to 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 before the date the data are due. The department may grant an extension for up to 30 calendar days. (c)Data verification, review and comment procedures.1. Each hospital shall review the plan for accuracy and completeness prior to submitting the plan to the department.2. The department shall notify a hospital if the plan or any elements of the plan appear to contain questionable data.3. The hospital shall either verify the accuracy of the plan or send a corrected plan to the department within 10 working days from the date the department notified the hospital of the questionable data. 4.a. Within the same 10-working day period under subd. 3., the chief executive officer or designee of each hospital shall submit to the department a signed affirmation statement.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.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.(d)Data adjustment methods. There shall be no adjustment methods for uncompensated health care services report data submitted by hospitals.(e)Waiver from data submission requirements. There shall be no waivers from the data submission requirements under this subsection.(2) HOSPITAL FISCAL SURVEY. (a)Definition. In this subsection, "mental health institute" has the meaning given in s. 51.01(12), Stats.(b)Data to be collected.1. `General hospital data.' Hospitals shall report all of the following financial data to the department in the format specified by the department, in accordance with this subsection and department instructions that are based on guidelines from the 2003 update of the Health Care Organizations - AICPA Audit and Accounting Guide, published by the American institute of certified public accountants, generally accepted accounting principles and the national annual survey of hospitals conducted by the American hospital association. a. Gross revenue the hospital derives from services it provides to patients and the sources of that revenue.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.c. Net revenue from service to patients.i. Expenses for education activities approved by medicare under 42 CFR 412.113(b) and 412.118 as excerpted from total expenses.j. Nonoperating gains and losses.m. Unrestricted liabilities and fund balances.n. Restricted hospital funds.o. Total gross revenue figures for the current and previous fiscal years.p. Total net revenue figures for the current and previous fiscal years.q. The dollar difference between gross and net revenue figures for the current and previous fiscal years.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.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:a. The number of patients whose accrued charges were attributed to charity care in that fiscal year.b. The total accrued charges for charity care, based on revenue foregone at full established rates, in that fiscal year.c. The number of patients whose accrued charges were determined to be a bad debt expense in that fiscal year.d. The total bad debt expense, as obtained from the hospital's final audited financial statements in that fiscal year.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: a. The hospital's projected number of patients anticipated to obtain charity care for that fiscal year.b. The hospital's projected total charges attributed to charity care for that fiscal year.c. The hospital's projected number of patients anticipated to incur bad debt expenses.d. The hospital's projected total bad debt expense for that fiscal year.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. 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.5. `Hospitals other than mental health institutes.'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.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. 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. 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. 6. `Mental health institutes.' 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.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. c. A mental health institute is not required to submit the data specified under subd. 1. L. through m. (c)Data submission procedures.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). 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.
2.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. 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. (d)Data verification, review and comment procedures.1. Each hospital shall review the data for accuracy and completeness prior to submitting data to the department.2. The department shall check the accuracy and completeness of all submitted financial data.3. The department shall notify a hospital if any of the data appear questionable.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.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.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.7.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.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.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.(e)Data adjustment methods. There shall be no adjustment methods for final audited financial statement data submitted by hospitals.(f)Waiver from data submission requirements.1. There shall be no waivers from the data submission requirements under this subsection.2. Hospitals that close, merge or change their reporting fiscal year shall submit a partial final audited financial statement for the applicable partial year.(3) ANNUAL SURVEY OF HOSPITALS. (a)Definitions. In this subsection:1. "Board" means the certifying body for a medical specialty.2. "Health maintenance organization" has the meaning specified under s. 609.01(2), Stats.(b)Data to be collected. Hospitals shall submit to the department, in the format specified by the department, the following data: 1. Type of hospital ownership and tax status.2. Type of service that best describes the services the hospital provides.3. Types and status of accreditations, licensure and certifications.4. Existence of contracts with prepaid health plans, including health maintenance organizations, and other alternative health care payment systems.5. Provision of selected inpatient, ancillary and other services.6. Location of services provided.7. Number of patients using selected services.8. Number of beds and inpatient utilization for the total facility, including beds set up and staffed, admissions, discharges and days of care.9. Inpatient utilization by government payers for the total facility.10. Number of beds and utilization by selected inpatient services.11. Swing-bed utilization, if applicable, including average number of swing beds, discharges and days of care.12. Use of nursing home services, if applicable, including beds set up and staffed, discharges and days of care.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.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.(c)Data submission procedures.1. A hospital shall submit to the department the data specified in par. (b) according to a schedule specified by the department. 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.
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. 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.(d)Data verification, review and comment procedures.1. Each hospital shall review the data for accuracy and completeness prior to submitting the survey to the department.2. The department shall check the accuracy and completeness of all submitted information.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.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.5. After the department has made any revisions under subd. 3. in the information for a particular hospital, the department shall send the hospital a copy of all variables submitted by that hospital to the department or subsequently corrected by the department.6. The hospital shall review the survey for accuracy and completeness and shall supply the department within the 10 working days specified in subd. 4. after receipt of the questionable survey with any corrections. 7.a. Within the 10-working day period under subd. 4., the chief executive officer or designee of each hospital shall submit to the department a signed affirmation statement.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.c. If the department discovers survey errors after the department's release of the data or if a hospital representative notifies the department of survey errors after the department's release of the data, the department shall note the data errors as caveats to the completed datasets.(e)Data adjustment methods. There shall be no adjustment methods for annual hospital survey data submitted by hospitals.(f)Waiver from data submission requirements.1. There shall be no waivers from the data submission requirements under this subsection.2. Hospitals that close, merge or change their reporting fiscal year shall submit an annual survey [for] the applicable partial year. Note: A missing word is shown in brackets.
(4) PUBLISHED NOTICES OF HOSPITAL RATE INCREASES OR CHARGES IN EXCESS OF RATES. (a)Data to be collected. Under s. DHS 120.09(4), hospitals shall submit all newspaper notices and affidavits of publication to the department.(b)Data submission procedures. Under s. DHS 120.09(4), hospitals shall submit a newspaper notice and affidavit of publication to the department within 14 calendar days after the hospital receives the affidavit of publication. 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.
(c)Data verification, review and comment procedures. There shall be no verification, review and comment procedures for published notices submitted by hospitals.(d)Data adjustment methods. There shall be no adjustment methods for published notices submitted by hospitals.(e)Waiver from data submission requirements. There shall be no waivers from the data submission requirements under this subsection.(5) UNIFORM INPATIENT DISCHARGE DATA. (a)Data to be collected. Hospitals shall submit to the department all of the following data for each patient:1. Federal tax identification number of the hospital.2. Patient control number.3. Patient medical record or chart number.11. Patient discharge status.13. Adjusted total charges and components of those charges.15. Primary payer identifier and type.16. Secondary payer identifier and type.17. Principal and other diagnosis codes.18. External cause of injury codes.19. Principal and other procedure codes.20. Date of principal procedure.21. Attending physician license number.22. Other physician license number, if applicable.25. Type of bill identifying the location of service.26. Encrypted case identifier.27. Insured's policy number.28. Diagnosis present at admission.(b)Data submission procedures.1. Each hospital shall electronically submit the data elements required under par. (a). The method of submission, data formats and coding specifications shall be defined in the department's data submission manual. 2. Hospitals shall send the data to the department within 45 calendar days of the last day of each calendar quarter using the department's electronic submission system. Calendar quarters shall begin on January 1, April 1, July 1 and October 1 and shall end on March 31, June 30, September 30 and December 31.3. Upon written request, the department shall provide consultation to a hospital to enable the hospital to submit data according to department specifications.4. The department may grant an extension of the time limits specified under subd. 2. 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.5. Each hospital shall submit inpatient data electronically with physical specifications, format and record layout in accordance with the department's data submission manual. 6.a. To ensure confidentiality, hospitals using qualified vendors to submit data shall submit to the department an original trading partner agreement that has been signed and notarized by the qualified vendor and the hospital.b. Hospitals shall be accountable for their qualified vendor's failure to submit data in the formats required by the department.(c)Data verification, review and comment procedures. The data verification, review and comment procedures specified in s. DHS 120.11(1) to (3) shall apply.(d)Physician verification, review and comment on hospital-submitted claims data. The data verification, review and comment procedures specified in s. DHS 120.11(1), (2) and (4) shall apply.(e)Data adjustment methods. The department shall adjust health care charge and mortality information for case mix and severity using commonly acceptable methods and tools designed for administrative claims information to perform adjustments for a class of health care providers.(f)Waiver from data submission requirements. There shall be no waivers from the data submission requirements under this subsection.(g)Compliant data submission.1. To be considered compliant with this chapter, a facility's data submission shall be all of the following: a. Submitted to the department electronically, as specified in the data submission manual.b. Consist of an individual facility data file.c. Meet the department standard of 10% or fewer records that do not pass the department's error checking procedures on or before the data submission due date.2. Facilities that fail to achieve a compliant data submission as required under this subsection may be subject to forfeitures.(5m) EMERGENCY DEPARTMENT DATA. (a)Data to be collected. Hospitals shall submit to the department all of the following data for each patient:1. Federal tax identification number of the hospital.11. Patient discharge status.12. Attending emergency provider specialty.14. Patient county of residence.15. Primary payer identifier and type.16. Secondary payer identifier and type.17. Principal and other diagnosis codes.18. External cause of injury codes.19. Principal and other procedure codes.21. Attending emergency provider ID.22. Consulting provider ID.23. Consulting provider specialty.24. Performing provider ID.25. Performing provider type/specialty.26. Encrypted case identifier.27. Insured's policy number.28. Diagnosis present at arrival.29. Type of bill identifying the location of service.(b)Data submission procedures.1. Each hospital shall electronically submit to the department all data specified in par. (a). The method of submission, data formats and coding specifications shall be defined in the department's data submission manual. 2. Within 45 calendar days after the last day of each calendar quarter, each hospital shall submit to the department the data specified in par. (a) using the department's electronic data submission system. Calendar quarters shall begin on January 1, April 1, July 1 and October 1 and shall end on March 31, June 30, September 30 and December 31. 3. Upon written request, the department shall provide consultation to a hospital to enable the hospital to submit data according to department specifications.4. The department may grant an extension of the deadline specified under subd. 2. 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 before the date the data are due. The department may grant an extension for up to 30 calendar days. 5.a. To ensure confidentiality, hospitals using qualified vendors to submit data shall provide an original trading partner agreement to the department that has been signed by the qualified vendor and the hospital.b. Hospitals shall be accountable for their qualified vendor's failure to submit data in the formats and by the due dates specified by the department.(c)Data verification, review and comment procedures. The data verification, review and comment procedures specified in s. DHS 120.11(1) to (3) shall be used for this subsection.(d)Physician verification, review and comment procedures on hospital-submitted claims data. The data verification, review and comment procedures specified in s. DHS 120.11(1), (2) and (4) shall be used for this subsection.(e)Data adjustment methods. The department shall adjust health care charge and mortality information for case mix and severity using commonly acceptable methods and tools designed for administrative claims information to perform adjustments for a class of health care providers.(f)Waiver from data submission requirements. There shall be no waivers from the data submission requirements under this subsection.(g)Compliant data submission.1. To be considered compliant with this chapter, a hospital's data submission shall be all of the following: a. Submitted to the department via the department's electronic data submission system.b. Consist of an individual hospital data file.c. Meet the department standard of 10% or fewer records that do not pass the department's error checking procedures on or before the data submission due date.2. Hospitals that fail to achieve a compliant data submission as required under this subsection may be subject to forfeitures under s. DHS 120.10(5).(6) AMBULATORY SURGICAL DATA. (a)Definition. In this subsection "hospital-affiliated ambulatory surgical center" means an entity that is owned by a hospital and is operated exclusively for the purpose of providing surgical services to patients not requiring hospitalization, has an agreement with the federal centers for medicare and medicaid services under 42 CFR 416.25 and 416.30 to participate as an ambulatory surgery center, and meets the conditions set forth in 42 CFR 416.25 to 416.49.(b)Data to be collected.1. `Types of procedures reported.' Hospitals shall report to the department information relating to any ambulatory patient surgical procedure within any of the following general types: a. Operations on the integumentary system.b. Operations on the musculoskeletal system.c. Operations on the respiratory system.d. Operations on the cardiovascular system.e. Operations on the hemic and lymphatic systems.f. Operations on the mediastinum and diaphragm.g. Operations on the digestive system.h. Operations on the urinary system.i. Operations on the male genital system.k. Laparoscopy and hysteroscopy. L. Operations on the female genital system.m. Maternity care and delivery.n. Operations on the endocrine system.o. Operations on the nervous system.p. Operations on the eye and ocular adnexa.q. Operations on the auditory system.2. `Data elements collected.' Hospitals shall report information on specific ambulatory patient surgical procedures required under subd. 1. from a hospital outpatient department or a hospital-affiliated ambulatory surgical center. The following data elements shall be submitted for each surgical procedure: a. Federal tax identification number of the hospital.b. Patient control number.c. Patient medical record or chart number.d. Date of principal procedure.h. Adjusted total charges and components of those charges.i. Primary payer identifier and type.j. Secondary payer identifier and type.k. Principal and other diagnosis codes. L. External cause of injury codes.m. Principal and other procedure codes.n. Attending physician license number, if applicable.o. Other physician license number.s. Encrypted case identifier.t. Insured's policy number.(c)Data submission procedures.1. Each hospital shall submit to the department all data described in par. (a). The method of submission shall be defined in the department's data submission manual. 2. Within 45 calendar days after the end of each calendar quarter, each hospital shall submit to the department the surgical data specified in par. (a) for all ambulatory patient surgical procedures using the department's electronic submission system. The department's electronic submission system shall be described in the department's data submission manual. Calendar quarters shall begin on January 1, April 1, July 1 and October 1 and shall end on March 31, June 30, September 30 and December 31. 3. The department may grant an extension of the deadline specified under subd. 2. 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 before the date the data are due. The department may grant an extension for up to 30 calendar days.4. Each hospital shall submit ambulatory patient surgical data electronically with physical specifications, format and record layout in accordance with the department's data submission manual.5. Upon written request, the department shall provide consultation to a hospital to enable the requesting hospital to submit ambulatory patient surgical data according to the department's specifications. 6.a. To ensure confidentiality, hospitals using qualified vendors to submit data shall provide to the department an original trading partner agreement that has been signed and notarized by the qualified vendor and the hospital.b. Hospitals shall be accountable for their qualified vendor's failure to submit data in the formats required by the department.(d)Data verification, review and comment procedures. The data verification, review and comment procedures specified in s. DHS 120.11(1) to (3) shall apply.(e)Physician verification, review and comment procedures on hospital-submitted ambulatory surgical data. The data verification, review and comment procedures specified in s. DHS 120.11(1), (2) and (4) shall apply.(f)Data adjustment methods. The department shall adjust health care charge information for case mix and severity using commonly acceptable methods and tools designed for administrative claims information to perform adjustments for a class of health care providers.(g)Waiver from data submission requirements. There shall be no waivers from the data submission requirements under this subsection.(h)Compliant data submission.1. To be considered compliant with this chapter, a facility's data submission shall be all of the following: a. Submitted to the department electronically, as specified in the data submission manual.b. Consist of an individual facility data file.c. Meet the department standard of 10% or fewer records that do not pass the department's error checking procedures on or before the data submission due date.2. Facilities that fail to achieve a compliant data submission as required under this subsection may be subject to forfeitures.Wis. Admin. Code Department of Health Services DHS 120.12
Cr. Register, December, 2000, No. 540, eff. 1-1-01; CR 01-051: am. (5) (b) 6. a., (5) (g) 1.a., (6) (c) 6. a., (6) (h) 1. a., cr. (5m), Register September 2001 No. 549 eff. 10-1-01; CR 03-033: am. (2) (b) 1. (intro.), (3) (b) 11., (c) 1., (5) (b) 2., (5m) (b) 2., 5. a., (6) (a) and (c) 2., cr. (5m) (a) 30. and 31. Register December 2003 No. 576, eff. 1-1-04.