Section 120.13. Data 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.

16. Operations on the eye and ocular adnexa.

17. Operations on the auditory system.

(b) Data elements collected . Freestanding ambulatory surgery centers shall report information on specific ambulatory patient surgical procedures required under par. (a) . The center shall submit the following data elements for each surgical procedure:

1. Federal tax number of the freestanding ambulatory surgery center.

2. Patient control number.

3. Patient medical record or chart number.

4. Date of principal procedure.

5. Patient zip code.

6. Patient birth date.

7. Patient gender.

8. Adjusted total charges and components of those charges.

9. Primary payer identifier and type.

10. Secondary payer identifier and type.

11. Principal and other diagnosis codes.

12. External cause of injury codes.

13. Principal and other procedure codes.

14. Attending physician license number, if applicable.

15. Other physician license number.

16. Patient race.

17. Patient ethnicity.

18. Type of bill.

19. Encrypted case identifier.

20. Insured's policy number.

(2)   Data submission procedures.

(a) Each freestanding ambulatory surgery center shall electronically submit to the department, as described in the department's data submission manual, all data elements specified in sub. (1) for all ambulatory patient surgical procedures within 45 calendar days after the end of each calendar quarter. 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. The method of submission, data formats and coding specifications shall be defined in the department's data submission manual.

(b) The department may grant an extension of the time limits specified under par. (a) only when the center adequately justifies to the department the center's need for additional time. In this paragraph, "adequate justification" means a delay due to a strike, fire, natural disaster or catastrophic computer failure. A center 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.

(c) Upon written request, the department shall provide consultation to a freestanding ambulatory surgical center to enable the requesting center to submit ambulatory patient surgical data according to the department's specifications.

(d)

1. To ensure confidentiality, centers 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 ambulatory surgery center.

2. Centers shall be accountable for their qualified vendor's failure to submit and edit data in the formats required by the department.

(3)   Freestanding ambulatory surgery center data verification, review and comment procedures. The data verification, review and comment procedures specified in s. DHS 120.11 (1) to (3) shall apply.

(4)   Physician verification, review and comment on freestanding ambulatory surgery center-submitted data. The data verification, review and comment procedures specified in s. DHS 120.11 (1) , (2) and (4) shall apply.

(5)   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.

(6)   Waiver from data submission requirements. There shall be no waivers from the data submission requirements under this section.

(7)   Compliant data submission.

(a) To be considered compliant with this chapter, a facility's data submission shall be all of the following:

1. Submitted to the department electronically, as specified in the data submission manual.

2. Consist of an individual facility data file.

3. 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.

(b) 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. (2) (d) 1. and (7) (a) 1., Register September 2001 No. 549 eff. 10-1-01; CR 03-033 : am. (2) (a) Register December 2003 No. 576 , eff. 1-1-04.