Chapter DHS 120

DHS 120.12(5m)(b)5.b. 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.

DHS 120.12(5m)(c) (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.

DHS 120.12(5m)(d) (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.

DHS 120.12(5m)(e) (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.

DHS 120.12(5m)(f) (f) Waiver from data submission requirements. There shall be no waivers from the data submission requirements under this subsection.

DHS 120.12(5m)(g) (g) Compliant data submission.

DHS 120.12(5m)(g)1. 1. To be considered compliant with this chapter, a hospital’s data submission shall be all of the following:

DHS 120.12(5m)(g)1.a. a. Submitted to the department via the department’s electronic data submission system.

DHS 120.12(5m)(g)1.b. b. Consist of an individual hospital data file.

DHS 120.12(5m)(g)1.c. 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.

DHS 120.12(5m)(g)2. 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).

DHS 120.12(6) (6) Ambulatory surgical data.

DHS 120.12(6)(a) (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.

DHS 120.12(6)(b) (b) Data to be collected.

DHS 120.12(6)(b)1. 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:

DHS 120.12(6)(b)1.a. a. Operations on the integumentary system.

DHS 120.12(6)(b)1.b. b. Operations on the musculoskeletal system.

DHS 120.12(6)(b)1.c. c. Operations on the respiratory system.

DHS 120.12(6)(b)1.d. d. Operations on the cardiovascular system.

DHS 120.12(6)(b)1.e. e. Operations on the hemic and lymphatic systems.

DHS 120.12(6)(b)1.f. f. Operations on the mediastinum and diaphragm.

DHS 120.12(6)(b)1.g. g. Operations on the digestive system.

DHS 120.12(6)(b)1.h. h. Operations on the urinary system.

DHS 120.12(6)(b)1.i. i. Operations on the male genital system.

DHS 120.12(6)(b)1.j. j. Intersex surgery.

DHS 120.12(6)(b)1.k. k. Laparoscopy and hysteroscopy.

DHS 120.12(6)(b)1.L. L. Operations on the female genital system.

DHS 120.12(6)(b)1.m. m. Maternity care and delivery.

DHS 120.12(6)(b)1.n. n. Operations on the endocrine system.

DHS 120.12(6)(b)1.o. o. Operations on the nervous system.

DHS 120.12(6)(b)1.p. p. Operations on the eye and ocular adnexa.

DHS 120.12(6)(b)1.q. q. Operations on the auditory system.

DHS 120.12(6)(b)2. 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:

DHS 120.12(6)(b)2.a. a. Federal tax identification number of the hospital.

DHS 120.12(6)(b)2.b. b. Patient control number.

DHS 120.12(6)(b)2.c. c. Patient medical record or chart number.

DHS 120.12(6)(b)2.d. d. Date of principal procedure.

DHS 120.12(6)(b)2.e. e. Patient zip code.

DHS 120.12(6)(b)2.f. f. Patient birth date.

DHS 120.12(6)(b)2.g. g. Patient gender.

DHS 120.12(6)(b)2.h. h. Adjusted total charges and components of those charges.

DHS 120.12(6)(b)2.i. i. Primary payer identifier and type.

DHS 120.12(6)(b)2.j. j. Secondary payer identifier and type.

DHS 120.12(6)(b)2.k. k. Principal and other diagnosis codes.

DHS 120.12(6)(b)2.L. L. External cause of injury codes.

DHS 120.12(6)(b)2.m. m. Principal and other procedure codes.

DHS 120.12(6)(b)2.n. n. Attending physician license number, if applicable.

DHS 120.12(6)(b)2.o. o. Other physician license number.

DHS 120.12(6)(b)2.p. p. Patient race.

DHS 120.12(6)(b)2.q. q. Patient ethnicity.

DHS 120.12(6)(b)2.r. r. Type of bill.

DHS 120.12(6)(b)2.s. s. Encrypted case identifier.

DHS 120.12(6)(b)2.t. t. Insured’s policy number.

DHS 120.12(6)(c) (c) Data submission procedures.

DHS 120.12(6)(c)1. 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.

DHS 120.12(6)(c)2. 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.

DHS 120.12(6)(c)3. 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.

DHS 120.12(6)(c)4. 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.

DHS 120.12(6)(c)5. 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.

DHS 120.12(6)(c)6. 6.

DHS 120.12(6)(c)6.a. 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.

DHS 120.12(6)(c)6.b. b. Hospitals shall be accountable for their qualified vendor’s failure to submit data in the formats required by the department.

DHS 120.12(6)(d) (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.

DHS 120.12(6)(e) (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.

DHS 120.12(6)(f) (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.

DHS 120.12(6)(g) (g) Waiver from data submission requirements. There shall be no waivers from the data submission requirements under this subsection.

DHS 120.12(6)(h) (h) Compliant data submission.

DHS 120.12(6)(h)1. 1. To be considered compliant with this chapter, a facility’s data submission shall be all of the following:

DHS 120.12(6)(h)1.a. a. Submitted to the department electronically, as specified in the data submission manual.

DHS 120.12(6)(h)1.b. b. Consist of an individual facility data file.

DHS 120.12(6)(h)1.c. 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.

DHS 120.12(6)(h)2. 2. Facilities that fail to achieve a compliant data submission as required under this subsection may be subject to forfeitures.

DHS 120.12 History History: 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.

DHS 120.13 DHS 120.13 Data to be submitted by freestanding ambulatory surgery centers.

DHS 120.13(1) (1) Data to be collected.

DHS 120.13(1)(a) (a) Types of procedures reported. Freestanding ambulatory surgery centers shall report to the department information relating to any ambulatory patient surgical procedure within any of the following general types:

DHS 120.13(1)(a)1. 1. Operations on the integumentary system.

DHS 120.13(1)(a)2. 2. Operations on the musculoskeletal system.

DHS 120.13(1)(a)3. 3. Operations on the respiratory system.

DHS 120.13(1)(a)4. 4. Operations on the cardiovascular system.

DHS 120.13(1)(a)5. 5. Operations on the hemic and lymphatic systems.

DHS 120.13(1)(a)6. 6. Operations on the mediastinum and diaphragm.

DHS 120.13(1)(a)7. 7. Operations on the digestive system.

DHS 120.13(1)(a)8. 8. Operations on the urinary system.

DHS 120.13(1)(a)9. 9. Operations on the male genital system.

DHS 120.13(1)(a)10. 10. Intersex surgery.

DHS 120.13(1)(a)11. 11. Laparoscopy and hysteroscopy.

DHS 120.13(1)(a)12. 12. Operations on the female genital system.

DHS 120.13(1)(a)13. 13. Maternity care and delivery.