Billing and collection activity shall consider the rights, dignity, and physical and mental condition of the client and other responsible parties. Responsible parties with no ability to pay and without applicable insurance shall not be pursued for payment.
All billing and collection activity shall be pursued in a forthright and timely manner according to these rules:
Where applicable insurance exists, the insurance company shall be billed directly wherever possible by the unit with collection responsibility for the facility providing the service. Where a responsible party is covered by Medicare and private insurance, Medicare shall be billed for the full coverage it provides and the private insurance company shall be billed for any remaining amount. Medicaid, where applicable, is the payer of last resort. For services exempted by s. DHS 1.01 (4)
, third-party reimbursement shall be pursued where applicable, but direct billings to the client or other responsible parties shall not occur. Agencies shall follow the claims processing procedures of third-party payers to assure payment of claims.
Responsible private parties shall be billed for liability not covered by insurance, according to applicable provisions of s. DHS 1.03
(7) First billings to responsible parties who have an ability to pay or who have not provided full financial information.
Where it is anticipated third-parties will pay less than the full liability, the first billing to responsible parties shall be sent during the calendar month following the month in which services were provided, except where an agreement to delay billing exists. If a responsible party has not provided full financial information and the payment approval authority determines that it is unlikely that the responsible party is able to pay full uninsured liability, the payment approval authority may set an estimated payment amount which shall be adjusted retroactively after the responsible party has provided full financial information. A cover letter explaining the liability and arrangements for making payment shall accompany the first billing statement to the responsible person(s) billed.
(8) Content of billing statements to responsible parties.
The billing statement shall be designed to meet all the requirements of the uniform fee system in the laws, rules and this order and must allow for the following entries:
Any balance brought forward from the last statement.
Any services provided during the billing period with charges showing liability and adjustments for parental maximums (except billings to clients for full care) and adjustments for maximum monthly payment rate (except for inpatient accounts).
Total outstanding charges to date ((a) minus (b), plus (c)).
(9) Mailing billing statements.
When a statement or other correspondence is mailed to a responsible party, there shall be no information on the mailed item to indicate that the item is necessarily related to care or treatment for mental illness, developmental disability, alcoholism, drug abuse or any other condition treatable under the provisions of ch. 48
(10) Addressing billing statements.
Statements shall only be addressed to the following persons:
The client's spouse if the client is personally unable to pay the entire liability.
The guardian of the estate of a person adjudged incompetent under ch. 54, Stats.
A person appointed representative payee of social security or SSI benefits of a client or responsible party.
A person, agency or firm specifically designated through an informed release of information by the client or a person named in s. 51.30 (5) (a)
(11) Coordination where other liability exists.
Before billing responsible parties, agencies shall determine if a responsible party has outstanding payment responsibility from any previous social or mental hygiene service. Where such payment responsibility exists, the agency currently providing service shall inform the first agency of the party's present status and coordinate the application of payments from the responsible party according to s. DHS 1.03 (17)
and sub. (12)
. When charges are satisfied of the agency given priority, that agency shall notify the other agency to commence their billing.
Payments shall be applied to the oldest period of service for which a liability remains, except as provided in the following paragraphs of this subsection.
When a responsible party has liability for adult inpatient care and for some other type of service, payments shall not be applied to the adult inpatient liability until other liabilities have been satisfied according to these rules.
Payment from one responsible party shall have no effect on decreasing the liability of other responsible parties except as total liability is decreased.
When private insurers or government agencies make payments against claims or statements that specify dates of service, such payments shall be applied to liability for the period indicated.
For clients residing in facilities, payments from client's own income shall be applied to the liability incurred during the month the income is received except that retroactive benefits may be applied to liability incurred back to the date of entitlement. The priority of payments for clients residing in facilities is as follows:
DHS 1.05(13)(a)(a) Definition.
An account is considered delinquent when a determination has been made that ability to pay currently exists, that no payment has been made over a period of 90 days, and that 3 or more contacts have been made to secure a payment.
(b) Follow-up of accounts.
Each billing/collection unit shall have a procedure to review accounts periodically for follow-up. When no payment is made on the initial billing, a second billing showing accumulated monthly charges shall be sent during the next calendar month. A note shall be enclosed explaining the bill and the amount now due. No response after 30 days following the second billing suggests checking with the service staff to see if there are any known reasons why collection efforts should not be pursued. Options are to:
Modify the approach by writing individualized letters or making telephone or other contacts.
(bm) Determining courses of action for unclear cases.
The payment approval authority shall determine the course of action for unclear cases. Actions taken shall be documented in the client's collection file.
(c) Referral of accounts for collection.
Agencies shall refer accounts for collection when the accounts are considered delinquent as defined in par. (a)
and when the agency's own collection unit has completed required follow-up procedures.
The following channels shall be utilized, depending on their availability and potential for timely handling of the account:
District attorney or corporation counsel handling legal matters for the county department of social services, or 51.42, 51.437 or 46.23 board involved.
No referral may be made to a private collection agency or private law office without the written permission of the bureau of fiscal services.
The following information shall be sent to the collection unit when referring an account for collection:
Referring agencies are responsible to follow-up on the status of referred accounts.
Responsible parties involved shall be notified in writing when the agency plans to refer the account for collection.
(14) Enforcement of Parental Support for Court-ordered Substitute Care.
When a child is placed in substitute care, as defined in s. DHS 1.07 (2) (i)
, pursuant to an order under s. 48.355
, Stats., or under s. 938.355
, Stats., payment approval authorities shall use the provisions of ss. 46.10 (14) (e)
, Stats., and chs. 767
, Stats., as applicable, to enforce the collection of parental support payments.
DHS 1.05 History
Cr. Register, August, 1978, No. 272
, eff. 9-1-78; renum. (1) to be (1) (a), cr. (1) (b) to (e), renum. (2) to be (2) (a) and cr. (2) (b), renum. (5), (6) and (7) to be (6), (12) and (13), and am., cr. (5) and (7) to (11), Register, November, 1979, No. 287
, eff. 1-1-80; am. (12) (b) and (e), Register, December, 1980, No. 300
, eff. 1-1-81; correction in (2) (d) under s. 13.93 (2m) (b) 7., Stats., and in (3) under s. 13.93 (2m) (b) 4., Stats., Register, September, 1984
; am. (4), (7) and (13) (c) (intro.), Register, September, 1984, No. 345
, eff. 10-1-84; renum. (13) (c) 1. b. to be 1. c. and am., cr. (13) (c) 1. b., Register, December, 1987, No. 384
; corrections made under s. 13.93 (2m) (b) 6, Stats., Register, August, 1994, No. 464
; emerg. cr. (2) (c) and (14), eff. 1-22-97; cr. (2) (c), (14), am. (13) (c) 1. b., Register, August, 1997, No. 500
, eff. 9-1-97; correction in (10) (d) made under s. 13.92 (4) (b) 7., Stats., Register June 2008 No. 630
DHS 1.06 Record-keeping, reports, confidentiality requirements, and disclosure authority. DHS 1.06(1)
Except as provided in statutes and these rules, information regarding a client and all interested parties, collected by a facility or agency subject to these rules, shall remain confidential.
Confidentiality provisions shall not prohibit disclosure of information in the following situations:
Disclosure of financial and service information without informed consent for services provided under ch. 51, Stats.
, may be made to the department, the program director of a board established under s. 51.42
, Stats., a qualified staff member designated by the program director or a county department of social services only under conditions specified in s. 51.30
, Stats., and rules promulgated thereunder.
Disclosure of financial and service information without informed consent for all other services under the uniform fee system may be made to the department, qualified staff members of a board established under s. 51.42
, Stats., or qualified staff members of a county department of social services when the information disclosed is for billing and collection purposes.
Further disclosure of financial and service information obtained under pars. (a)
may be made without informed consent by a board established under s. 51.42
, Stats., or a county department of social services to the county district attorney or corporation counsel for the purpose of enforcing the collection of delinquent accounts in the courts.
DHS 1.06 Note
Note: The district attorney or corporation counsel must be seen as the legitimate counsel to the county agencies named in this section.
Billings sent to the following persons shall not constitute unlawful re-disclosure of financial or service information when such information is obtained by the agency in accordance with s. 51.30 (4) (b) 2.
The parent, guardian or person acting in loco parentis for a minor client.
The representative payee for benefits owing to the client from social security or SSI.
The guardian of the estate of a person adjudged incompetent under ch. 54, Stats.
Except where prohibited by a federal regulations relating to alcohol and drug treatment records, the persons named in s. 51.30 (5) (a)
, Stats., may consent in place of the client for the release of medical information in order to obtain insurance benefits owing to the client, the client's spouse or the parents of a client.
DHS 1.06(3)(a)(a) Records.
Clear, exact and auditable records shall be established and maintained for each client regardless of the client's financial status or services involved. Such information shall include:
The nature of the contact (professional service or paraprofessional service).
In the case of residential services, the actual days of care must be documentable.
DHS 1.06 Note
Note: This does not mean that all of these records must be reported to the agency's billing unit; but, if necessary, the provider's records should include or allow for each client, the potential for reporting to the billing unit enough information to prepare a billing statement that establishes liability for and by each calendar month during which services are provided.
(b) Individual account control record.
Each billing and collection unit has broad flexibility to design a system that best fits the agency's needs and also satisfies the requirements of the uniform fee system. A record system is required that brings together all units of services provided for those clients whose accounts must be set up for billing a responsible party or third-party under the uniform fee system. For such cases, financial information forms and other information to prepare billings must be reported to the billing unit. The billing and collection unit is responsible for posting data to individual account control records from information received as soon as possible, including services provided and payments made as well as dates of service and dates of payments.
(c) Client collection file.
There shall be a client collection file for every account billed. The file shall include:
Copies of financial information forms for all responsible parties who elect to be billed according to their ability to pay.
Updated information after each year (6 months for social service clients) concerning the family's ability to pay when billing extends for more than one year (6 months for social service clients).
Closing client records; record retention period.
Client records may be closed after the department or payment approval authority determines that any one of the conditions listed under s. DHS 1.03 (20) (a)
applies. Closed client records shall be maintained for at least 5 years.
(4) Agency records.
Each agency or facility covered by these rules shall keep complete, clear, and exact records of allocation of staff time, service units delivered, and all revenues and gross expenditures.
(5) Required reports.
Each facility or agency covered by these rules shall submit to the department such reports on client liability, billings, and collections as the department may require.
DHS 1.06 History
Cr. Register, August, 1978, No. 272
, eff. 9-1-78; am. (1), r. and recr. (2) (a) and (b), cr. (2) (c) to (e), r. and recr. (3) (a), renum. (3) (b) and (c) to be (3) (d) and (e), cr. (3) (b) and (c), Register, November, 1979, No. 287
, eff. 1-1-80; correction in (2) (d) 5. made under s. 13.92 (4) (b) 7.
, Stats., Register June 2008 No. 630
; CR 10-146
: r. and recr. (3) (d), r. (3) (e) Register May 2011 No. 665
, eff. 6-1-11.
DHS 1.065 Children's long-term support parental payment limits. DHS 1.065(1)(a)(a)
This section establishes a parental payment limit for certain children's long-term support services identified in this subsection. These provisions apply to all county administrative agencies that administer the services to which this section applies.
This section applies to children's services of a type that may be reimbursed under a waiver under the disabled children's long-term support program as defined in s. 46.011 (1g)
, Stats., regardless of whether those services are actually reimbursed under that program, under the community integration program waivers under s. 46.275
, Stats., under the community options program waiver under s. 46.27 (11)
, Stats., or otherwise with federal, state or county funds.
This section applies to services for children under the family support program under s. 46.985