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 identify the 25 most common conditions for which the provider provides services;
• Identify the methods by which the health care provider must calculate and present median billed charges and Medicare and private third party payer payments;
• Consult with other organizations that develop measures for assessing quality of health care services, guide data validity and accuracy, report results of quality assessments, and share best practices of health care service providers.

Health care providers must disclose to a health care consumer the median billed charge for a health care service, upon the consumer’s request and within a reasonable time from when the request was made.   A health care provider that submits data to a data organization must, when providing a consumer with charge information, also provide any public information reported by the data organization regarding the quality of health care services compared to other providers for the specific service to be performed on the consumer.  The health care provider can give the consumer a paper copy containing the information or by directing the consumer to a website where the information is posted.  If the provider submits information to multiple data organizations, the law only requires that the provider give consumers comparative quality information from one of the data organizations. 

Health care providers must submit a single document that lists the following charge information for the 25 most common conditions the provider treats:

• Median billed charge
• Medicare payment to the provider (if a Medicare provider)
• Average allowable payment from third party payers

A health care provider that submits data to a data organization must also provide the data organization with any public information reported by the data organization regarding the quality of health care services compared to other providers that is relevant to any of the conditions that the provider is required to report on.  The health care provider can give submit the information by attaching a paper copy containing the information or by providing the website where the information is posted.  If the provider submits information to multiple data organizations, the law only requires that the provider give comparative quality information from one of the data organizations.  This information must also be provided to a consumer upon request and at no charge, but does not constitute a legally binding estimate of the charge. 

A health care provider must prominently display in the practice area, a notice informing the patient of their right to receive charge information and comparative quality information noted above.  This requirement does not apply to providers who practice individually or with less than 2 other individual providers or a provider that is an association of three or fewer individual providers. 

Each hospital must prepare a single document containing the following charge information for 75 specific diagnosis-related groups for inpatient care and 75 specific outpatient surgical procedures:

• Median billed charge
• Average allowable Medicare payment
• Average allowable payment from third party payers

A hospital that submits data to a data organization must also provide the data organization with any public information reported by the data organization regarding the quality of health care services compared to other hospitals that is relevant to any of the 75 inpatient or outpatient procedures that the hospital is required to report on.  The hospital can give submit the information by attaching a paper copy containing the information or by providing the website where the information is posted.  If the provider submits information to multiple data organizations, the law only requires that the provider give comparative quality information from one of the data organizations on a specific inpatient diagnosis related group or outpatient surgical procedure.  This information must also be provided to a consumer upon request and at no charge, but does not constitute a legally binding estimate of the charge.  Hospitals must update the information each quarter.  Hospitals must prominently display in the practice area, a notice informing the patient of their right to receive charge information and comparative quality information noted above.

Violations of the reporting requirements for health care providers and hospitals outlined above may be subject to a $250 per violation.  The Department may directly assess the penalties or forfeitures by sending a notice.  An alleged violator may contest the assessment and may submit a written request for a hearing.  All penalties must be paid either within 10 days of receiving the notice, or if contested, within 10 days from the final decision.  If a forfeiture is outstanding, the attorney general may commence an action to collect the sum.