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. DHS 120.03(17)(17) “Health care service charge” means the full amount billed for medical services before being reduced by any contractual adjustments or other discounts. DHS 120.03(19)(19) “Independent review board” or “IRB” means a department board established under s. 15.195 (9), Stats., for the purpose of reviewing requests to release department data on physician office visits that, if inappropriately released, may jeopardize the privacy of individual patients or health care providers. DHS 120.03(20)(20) “Individual data elements” means items of information from or derived from a uniform patient billing form or an electronic transaction and code set standard for health care. DHS 120.03(22)(22) “Medicare” means the health insurance program operated by the U.S. department of health and human services under 42 USC 1395 to 1395 ccc and 42 CFR ch. IV, subch. B. DHS 120.03(24)(24) “Payer” means a party responsible for payment of a health care service charge, including an insurer or a federal, state or local government. DHS 120.03 NoteNote: Payers often reimburse health care providers a substantially lesser amount than the full charge.
DHS 120.03(25)(25) “Person” means any individual, partnership, association or corporation, the state or a political subdivision or agency of the state or of a local unit of government. DHS 120.03(26)(26) “Physician” means a person licensed under ch. 448, Stats., to practice medicine or osteopathy. DHS 120.03(27)(27) “Public program” means any program funded with government funds. DHS 120.03(28)(28) “Public use data” means any form of data from the department’s comprehensive discharge database or facility level database that does not allow the identification of an individual from the elements released in the data files. DHS 120.03(29)(29) “Qualified vendor” means an entity under contract with a health care provider that will submit data to the department according to formats the department specifies in its data submission manual. DHS 120.03(30)(30) “Raw data elements” means any file, individual record, or any subset thereof, that contains information about an individual health care service provided to a single patient released by the department in public use or custom data files.