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. DHS 120.03 NoteNote: Examples of raw data elements are any of the following:
DHS 120.03 Notea. The data files hospitals and surgery centers submit to the department each quarter.
DHS 120.03 Noteb. The public-use data files the department produces.
DHS 120.03 Notec. Any custom data file produced by the department that contains individual records representing hospital discharges or surgical cases. Some customers purchase this kind of data when it is more cost-effective than purchasing the complete statewide public-use data files.
DHS 120.03 Noted. A computer printout of the individual data elements in individual records representing hospital discharges or surgical cases.
DHS 120.03(31)(31) “Reportable price increase” means a change in a hospital’s prices that, by itself or combined with other price increases during the preceding 12 months, causes the percentage increase in the hospital’s total gross revenue from patient services for the 12 months following the change to be greater than the change in the consumer price index. DHS 120.03(32)(32) “Sign” or “signature” means any combination of words, letters, symbols or characters that is attached to or logically associated with a record and that is used by a person for the purpose of authenticating a document, including one that has been created in or transformed into an electronic format. DHS 120.03(33)(33) “Subacute care” means goal-oriented, comprehensive, inpatient care designed for an individual who has had an acute illness, injury or exacerbation of a disease process. It is rendered immediately after, or instead of, acute hospitalization to treat one or more specific, active, complex medical conditions or to administer one or more technically complex treatments in the context of a person’s underlying long-term conditions and overall situation. Subacute care is generally more intensive than traditional nursing facility care and less intensive than acute inpatient care. DHS 120.03(34)(34) “Trading partner agreement” means a signed, formal arrangement between a health care provider and a qualified vendor providing the transfer of data under this chapter. The agreement specifies the acceptable data formats, the edit review and verification requirements, including procedures for processing confidential patient data and the authorized signatory for the affirmation statement. DHS 120.03(35)(35) “Uncompensated health care services” means charity care and bad debts. DHS 120.03(36)(36) “Uniform patient billing form” means forms consistent with federal data standards for health care payment transactions.