Section 11.16. Procedures for payment of awards of examination costs.

 

(1)   Itemized bill. A health care provider seeking an award for examination costs shall provide an itemized bill to the department with individual charges listed for each service for which reimbursement is sought. Only one itemized bill shall be submitted for each examination. The health care provider shall also indicate the amount sought for all of the following categories of examination costs:

(a) Services of the provider.

(b) Facilities used for the examination.

(c) Any other expenses.

(2)   No billing of victim. Per s. 949.26 (2) (a) , Stats., a health care provider seeking an award under this subchapter may not seek payment for any examination costs from the victim or any guardian of the victim.

(3)   Payment directly to health care provider. The department will pay the award directly to the health care provider that performed the examination.

(4)   Maximum amount of award. The department will pay two-thirds of the amount billed for eligible services, up to a maximum of $1200 for each examination. In exceptional cases, the department in its sole discretion may approve an award in excess of the maximum amount if the health care provider submits evidence that that maximum amount did not fairly and equitably compensate it for the costs incurred in conducting the examination. Beginning January 1, 2017, the maximum amount of an award shall be adjusted annually by the "inflation factor" as defined in s. 79.05 (1) (am) , Stats., and certified by the department of revenue under s. 79.05 (2m) , Stats.

History: CR 15-058 : cr. Register May 2016 No. 725 .