DHS 120.14(2)(a)2. 2. ‘Hospital privileges update.’ Physicians shall report hospital privilege changes to the department within 30 days of the hospital’s granting of the privileges or the discontinuance of the privileges.

DHS 120.14(2)(b) (b) Data submission procedures. Physicians shall report the information in par. (a) to the department through the department’s internet submission system. Physicians without access to the internet shall fax or mail their changes to the department.

DHS 120.14 Note Note: For the purposes of par. (b), the Department’s address is 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. The Bureau of Health Information and Policy’s fax number is 608-264-9881.

DHS 120.14(2)(c) (c) Data verification, review and comment procedures. The department shall, within 15 working days, send an acknowledgement to the reporting physician verifying the self-report and inviting the physician to submit corrected data within 10 working days.

DHS 120.14(2)(d) (d) Data adjustment methods. There shall be no adjustment methods for data submitted under this subsection.

DHS 120.14(2)(e) (e) Waiver from data submission requirements. There shall be no waivers from the data submission requirements under this subsection.

DHS 120.14(3) (3) Physician survey.

DHS 120.14(3)(a) (a) Data to be collected. The department shall collect all of the following types of workforce and practice information:

DHS 120.14(3)(a)1. 1. Name of the physician and address or addresses of main practice or employment.

DHS 120.14(3)(a)2. 2. Active status information.

DHS 120.14(3)(a)3. 3. License or certification status, including date of initial licensure or certification, credential suspensions or revocations.

DHS 120.14(3)(a)4. 4. Medical education and training information.

DHS 120.14(3)(a)5. 5. Specialty, board certification and recertification information.

DHS 120.14(3)(a)6. 6. Teaching focus information, if applicable.

DHS 120.14(3)(a)7. 7. Practice information, including practice name, location, phone number, hours spent at location and provision of obstetrical, pediatric or prenatal care.

DHS 120.14(3)(a)8. 8. Whether the physician renders services to medicare and medical assistance patients and, if applicable, whether the physician has signed a medicare participation agreement indicating that she or he accepts assignment on all medicare patients.

DHS 120.14(3)(a)9. 9. Whether the physician participates in a voluntary partnercare program specified under s. 71.55 (10), Stats., under which assignment is accepted for low-income elderly.

DHS 120.14 Note Note: Section 71.55 (10), Stats., was repealed by 2003 Wis. Act 33.

DHS 120.14(3)(a)10. 10. Date, state and county of most recent residency.

DHS 120.14(3)(a)11. 11. Current names and addresses of facilities at which the physician has been granted privileges.

DHS 120.14(3)(a)12. 12. The usual and customary charges for office visits, routine tests and diagnostic workups, preventive measures and frequently occurring procedures, as specified by the department.

DHS 120.14(3)(a)13. 13. Health plan affiliations.

DHS 120.14(3)(b) (b) Data submission procedures.

DHS 120.14(3)(b)1. 1. Physicians shall return the survey to the department within 30 days of receiving it. Receipt of data is presumed within 5 days of the date the notice was mailed.

DHS 120.14(3)(b)2. 2. The department may grant an extension of a deadline specified in subd. 1. for submission of information only when the physician adequately justifies to the department the physician’s need for additional time. In this subdivision, “adequate justification’’ means a delay due to a labor strike, fire, natural disaster or catastrophic computer failure. A physician 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. Physicians who have been granted an extension by the department shall submit their data directly to the department.

DHS 120.14 Note Note: Physicians 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.

DHS 120.14(3)(c) (c) Data verification, review and comment procedures. Physicians shall verify or correct information contained on their survey. The department shall verify questionable information by contacting the applicable physician.

DHS 120.14(3)(d) (d) Data adjustment methods. There shall be no adjustment methods for data submitted under this subsection.

DHS 120.14(3)(e) (e) Waiver from data submission requirements. There shall be no waivers from the data submission requirements under this subsection.