The state of Wisconsin does not have a large number of regulations that outlines provider utilization and financial reporting. However, based on the research that was conducted, hospitals and ambulatory surgery centers are required to provide a report annually on utilization, charge, and quality data on patients treated in their respective facilities.1
| Subtopic | Statute/Regulation | Description |
|---|
| Required utilization/cost reporting | Collection and dissemination of health care and related information – Wis. Stat. Ann. § 153.05 | Collection and Dissemination of health care and related information The purpose of this section is to give providers, consumers, insurers, and... |
| Data to be submitted by hospitals – Wis. Admin. Code DHS §120-12 | Data to be submitted by hospitals This regulation requires that hospitals submit a number of different types of data to DHS. Uncompensated health... | |
| Patient-level data utilization, charge, and quality report – Wis. Stat. Ann. § 153.22 | The contracted entity must prepare an annual report that outlines utilization, charge, and quality data on patients treated by hospitals and... |
| Provider cost reporting | Data to be submitted by physician class of provider – Wis. Admin. Code DHS §120-14 | Data to be submitted by physicians to DHS The Department of Health Services requires physicians to submit certain kinds of data to them on a regular... |
| Disclosures required of health care providers and hospitals – Wis. Stat. Ann. § 146.903 | The Wisconsin Department of Health Services must identify ways for providers to calculate median billed charges. In conducting its duties, the... | |
| Disclosures required of health care providers and hospitals – Wis. Stat. Ann. § 146.903 | The Department of Health Services must do the following: Categorize health care providers by type; For each type of provider, annually... | |
| General Provisions – Wis. Admin. Code DHS §120-20 | General provisions for standard reports by DHS This regulation requires that the department of health services prepare a certain list of standard... | |
| Hospital rate increases or charges in excess of rates – Wis. Stat. Ann. § 153.08 | No hospital may increase its rates or charge payers more than the rates in effect unless the hospital publishes a notice outlining the rate increase... |
| Access to health care cost information | Disclosures required of health care providers and hospitals – Wis. Stat. Ann. § 146.903 | The Wisconsin Department of Health Services must identify ways for providers to calculate median billed charges. In conducting its duties, the... |
| Disclosures required of health care providers and hospitals – Wis. Stat. Ann. § 146.903 | The Department of Health Services must do the following: Categorize health care providers by type; For each type of provider, annually... |
| Resource Use (Cost/Utilization) Measurement and Reporting | Wis. Admin. Code DHS §124-11 - Utilization Review | This law requires that every hospital have a written utilization review plan to maximize patient care quality care while minimizing over or under-... |
| Wis. Admin. Code DHS §61-07 - Uniform Cost Reporting - Community Mental Health and Developmental Disabilities Services | This law requires that community programs receiving state funds for providing community mental health and developmental disabilities services utilize... | |
| Wis. Admin. Code DHS §66-10 - Data Collection - Treatment Alternative Program | Upon DHS's request, each Treatment Alternative Program (TAP) agency must submit the following program to DHS: Number of potential clients... |
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