DHS 120.02DHS 120.02 Applicability. This chapter applies to the department, the board on health care information, the independent review board, qualified vendors, health care plans, health care providers licensed in this state and persons requesting data from the department.

DHS 120.03(1)(1) “Affirmation statement” means a department document that when signed by a health care provider or an authorized representative of a health care provider submitting data to the department affirms, to the best of the signer’s knowledge, all of the following:

DHS 120.03(1)(a)(a) Any necessary corrections to data submitted to the department have been made.

DHS 120.03(2)(2) “Bad debts” means claims arising from rendering patient care services that the hospital, using a sound credit and collection policy, determines are uncollectible, but does not include charity care.

DHS 120.03(3)(3) “Board” means the board on health care information established under s. 15.195 (6), Stats.

DHS 120.03(4)(4) “Charity care” means health care a hospital provides to a patient who, after an investigation of the circumstances surrounding the patient’s ability to pay, including nonqualification for a public program, is determined by the hospital to be unable to pay all or a portion of the hospital’s normal billed charges. “Charity care” does not include any of the following:

DHS 120.03(4)(a)(a) Care provided to patients for which a public program or public or private grant funds pay for any of the charges for the care.

DHS 120.03(4)(b)(b) Contractual adjustments in the provision of health care services below normal billed charges.

DHS 120.03(4)(c)(c) Differences between a hospital’s charges and payments received for health care services provided to the hospital’s employees, to public employees or to prisoners.

DHS 120.03(4)(d)(d) Hospital charges associated with health care services for which a hospital reduces normal billed charges as a courtesy.

DHS 120.03(5)(5) “Contractual adjustment” means the difference between a hospital’s full amount billed for medical services for patient services and the discounted charge or payment received by the hospital from the payer.

DHS 120.03(6)(6) “Data profile” means a summary of all submitted data and a summary of the number of records received by the department from a health care provider.

DHS 120.03(7)(7) “Data submission manual” means the department’s document specifying the procedures for submitting data, including data formats, coding specifications and instructions for editing incorrect data.

DHS 120.03(8)(8) “Data summary” means a report summarizing what the health care provider submitted, including number of records, and a listing of all questionable data records.

DHS 120.03(9)(9) “Department” means the department of health services.

DHS 120.03(9m)(9m) “Emergency department” means a distinct, dedicated area within a hospital with the staffing and resources to provide continuously available assessment, stabilization and initial management of patients presenting with conditions throughout the spectrum of acute illness and injury.

DHS 120.03(10)(10) “Employer coalition” means an organization of employers formed for negotiating terms for the purchase of health care coverage or services as a group.

DHS 120.03(11)(11) “Facility” means a hospital, freestanding ambulatory surgery center, inpatient health care facility as defined in s. 50.135 (1), Stats., hospice, community-based residential facility or rural medical center.

DHS 120.03(12)(12) “Facility level database” means a database pertaining to a facility, including aggregated utilization, staffing or fiscal data for the facility but not including data on an individual patient or data on an individual health care professional.

DHS 120.03(13)(13) “Freestanding ambulatory surgery center” or “center” means any distinct entity that is operated exclusively for the purpose of providing surgical services to patients not requiring hospitalization, that 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 that meets the conditions set forth in 42 CFR 416.25 to 416.49.

DHS 120.03(14)(14) “Gross revenue” means the total charges generated by hospitals to inpatients and outpatients for services provided regardless of the amount a hospital actually expects to collect.

DHS 120.03(15)(15) “Health care plan” means any insured or self-insured plan providing coverage of health care expenses.

DHS 120.03(16)(16) “Health care provider” has the meaning given in s. 146.81 (1), Stats., and includes a freestanding ambulatory surgery center.