Chapter DHS 120

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.

DHS 120.13(1)(a)14. 14. Operations on the endocrine system.

DHS 120.13(1)(a)15. 15. Operations on the nervous system.

DHS 120.13(1)(a)16. 16. Operations on the eye and ocular adnexa.

DHS 120.13(1)(a)17. 17. Operations on the auditory system.

DHS 120.13(1)(b) (b) Data elements collected. Freestanding ambulatory surgery centers shall report information on specific ambulatory patient surgical procedures required under par. (a). The center shall submit the following data elements for each surgical procedure:

DHS 120.13(1)(b)1. 1. Federal tax number of the freestanding ambulatory surgery center.

DHS 120.13(1)(b)2. 2. Patient control number.

DHS 120.13(1)(b)3. 3. Patient medical record or chart number.

DHS 120.13(1)(b)4. 4. Date of principal procedure.

DHS 120.13(1)(b)5. 5. Patient zip code.

DHS 120.13(1)(b)6. 6. Patient birth date.

DHS 120.13(1)(b)7. 7. Patient gender.

DHS 120.13(1)(b)8. 8. Adjusted total charges and components of those charges.

DHS 120.13(1)(b)9. 9. Primary payer identifier and type.

DHS 120.13(1)(b)10. 10. Secondary payer identifier and type.

DHS 120.13(1)(b)11. 11. Principal and other diagnosis codes.

DHS 120.13(1)(b)12. 12. External cause of injury codes.

DHS 120.13(1)(b)13. 13. Principal and other procedure codes.

DHS 120.13(1)(b)14. 14. Attending physician license number, if applicable.

DHS 120.13(1)(b)15. 15. Other physician license number.

DHS 120.13(1)(b)16. 16. Patient race.

DHS 120.13(1)(b)17. 17. Patient ethnicity.

DHS 120.13(1)(b)18. 18. Type of bill.

DHS 120.13(1)(b)19. 19. Encrypted case identifier.

DHS 120.13(1)(b)20. 20. Insured’s policy number.

DHS 120.13(2) (2) Data submission procedures.

DHS 120.13(2)(a) (a) Each freestanding ambulatory surgery center shall electronically submit to the department, as described in the department’s data submission manual, all data elements specified in sub. (1) for all ambulatory patient surgical procedures within 45 calendar days after the end of each calendar quarter. 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. The method of submission, data formats and coding specifications shall be defined in the department’s data submission manual.

DHS 120.13(2)(b) (b) The department may grant an extension of the time limits specified under par. (a) only when the center adequately justifies to the department the center’s need for additional time. In this paragraph, “adequate justification” means a delay due to a strike, fire, natural disaster or catastrophic computer failure. A center 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 120.13(2)(c) (c) Upon written request, the department shall provide consultation to a freestanding ambulatory surgical center to enable the requesting center to submit ambulatory patient surgical data according to the department’s specifications.

DHS 120.13(2)(d) (d)

DHS 120.13(2)(d)1. 1. To ensure confidentiality, centers 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 ambulatory surgery center.

DHS 120.13(2)(d)2. 2. Centers shall be accountable for their qualified vendor’s failure to submit and edit data in the formats required by the department.

DHS 120.13(3) (3) Freestanding ambulatory surgery center 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 120.13(4) (4) Physician verification, review and comment on freestanding ambulatory surgery center-submitted data. The data verification, review and comment procedures specified in s. DHS 120.11 (1), (2) and (4) shall apply.

DHS 120.13(5) (5) 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 120.13(6) (6) Waiver from data submission requirements. There shall be no waivers from the data submission requirements under this section.

DHS 120.13(7) (7) Compliant data submission.

DHS 120.13(7)(a) (a) To be considered compliant with this chapter, a facility’s data submission shall be all of the following:

DHS 120.13(7)(a)1. 1. Submitted to the department electronically, as specified in the data submission manual.

DHS 120.13(7)(a)2. 2. Consist of an individual facility data file.

DHS 120.13(7)(a)3. 3. 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 120.13(7)(b) (b) Facilities that fail to achieve a compliant data submission as required under this subsection may be subject to forfeitures.

DHS 120.13 History History: Cr. Register, December, 2000, No. 540, eff. 1-1-01; CR 01-051: am. (2) (d) 1. and (7) (a) 1., Register September 2001 No. 549 eff. 10-1-01; CR 03-033: am. (2) (a) Register December 2003 No. 576, eff. 1-1-04.

DHS 120.14 DHS 120.14 Data to be submitted by physician class of provider.

DHS 120.14(1) (1) Claims data.

DHS 120.14(1)(a) (a) Data to be collected. Physicians shall submit all of the following data elements:

DHS 120.14(1)(a)1. 1. Patient’s birth date.

DHS 120.14(1)(a)2. 2. Patient’s gender.

DHS 120.14(1)(a)3. 3. Patient zip code.

DHS 120.14(1)(a)4. 4. Patient condition related to employment.

DHS 120.14(1)(a)5. 5. Patient condition related to auto accident.

DHS 120.14(1)(a)6. 6. Patient condition related to other accident.

DHS 120.14(1)(a)7. 7. Date of current illness, injury or pregnancy.

DHS 120.14(1)(a)8. 8. The first date of illness, if patient has had same or similar illness.

DHS 120.14(1)(a)9. 9. Primary payer category code.

DHS 120.14(1)(a)10. 10. Secondary payer category code.

DHS 120.14(1)(a)11. 11. Medical record or chart number.

DHS 120.14(1)(a)12. 12. Name of referring physician.