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(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.
j. Intersex surgery.
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.
e. Patient zip code.
f. Patient birth date.
g. Patient gender.
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.
p. Patient race.
q. Patient ethnicity.
r. Type of bill.
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.
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.
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 120.13Data to be submitted by freestanding ambulatory surgery centers.
(1)Data to be collected.
(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:
1. Operations on the integumentary system.
2. Operations on the musculoskeletal system.
3. Operations on the respiratory system.
4. Operations on the cardiovascular system.
5. Operations on the hemic and lymphatic systems.
6. Operations on the mediastinum and diaphragm.
7. Operations on the digestive system.
8. Operations on the urinary system.
9. Operations on the male genital system.
10. Intersex surgery.
11. Laparoscopy and hysteroscopy.
12. Operations on the female genital system.
13. Maternity care and delivery.
14. Operations on the endocrine system.
15. Operations on the nervous system.
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Published under s. 35.93, Stats. Updated on the first day of each month. Entire code is always current. The Register date on each page is the date the chapter was last published.