Last updated: January 7, 2022
**Premium Holiday Announced from July 1, 2020 until June 30, 2023.**
The Injured Patients and Families Compensation Fund's (Fund) billing process is started by the receipt of a certificate of primary malpractice insurance from a licensed carrier. The certificate includes information that allows the Fund to group physicians into four classes based on provider specialty. Physician specialties are identified by the applicable insurance services office (ISO) codes in ch. Ins 17, Wis. Adm. Code. The ISO codes and their class assignment can also be found in the Fee Schedule. Assessments for Certified Registered Nurse Anesthetists (CRNA) and eligible facilities can also be found in the Fee Schedule.
Fund Fees for Fiscal Year 2020 (July 1, 2019 - June 30, 2020)
Fund Fees for Fiscal Year 2019 (July 1, 2018 - June 30, 2019)
Class 1 includes specialties with the lowest risk and is therefore priced at the lowest rate. Class 4 represents the greatest risk and is priced at the highest rate. Rates will differ for medical school residents, Medical College of Wisconsin faculty members, physicians practicing a limited number of hours in a fiscal year, and locum tenen physicians whose principal place of practice is not in Wisconsin.
Annual Fund premium rates are set by the Board of Governors (Board) with the approval of the state legislature. The fee-setting process begins with an actuarial assessment of expected loss exposure based on prior years' experience. The other primary factor in determining annual fee adjustments is the overall financial position of the Fund. An actuarial consultant performs an analysis of the Fund's loss experience and submits fee recommendations to the Fund's Actuarial and Underwriting Committee. After review, the committee will recommend a fee increase or decrease to the Board. The Board then authorizes either an increase or decrease. A rule is then promulgated by the Office of the Commissioner of Insurance (OCI) in accordance with ch. 227, Wis. Stat.
The Fund's fiscal year runs from July 1 through June 30. The annual assessment is billed in June for the upcoming fiscal year, or in the case of mid-term filings, at the next subsequent quarterly billing.
A refund of a credit balance will be issued to the provider named on the account by request. A third party requesting that a refund be sent to them must include a signed statement from the provider authorizing the refund be issued to someone other than the account holder (health care provider).
The assessment fee is payable on an annual or on a quarterly installment basis. The provider may pay the balance of the account when the bill is received or elect to pay on an installment basis; he or she must then pay at least the minimum quarterly amount due. In the event that the balance is not received at the Fund's Milwaukee lockbox by the payment due date, an administrative fee assessment of $3.00 per quarter is applied to the account.
An annually determined interest rate will be assessed on any deferred balance. The rate applied is the same rate at which the Fund earns interest on its short-term account. Interest charges appear on the bill subsequent to the period in which charges are incurred.
All doctors, other than medical residents, are required to pay an annual mediation panel fee. The Medical Mediation Panels are operated by the Clerk of the Wisconsin Supreme Court. All medical malpractice claims must go through the mediation process before they can proceed to court. More information about the panels can be found at the Web site of the
Director of State Courts .
Group Billing Accounts and Linking
Employers may choose to link employed providers and facilities to a group billing account. Billing statements are sent to the address on file for each individual provider unless the provider is linked to a group billing account. Bills for providers linked to a group billing account are sent with an Employer Billing Summary listing the account name, account number, total amount due, and minimum amount due for each linked provider.
Problems and misapplied payments can occur when changes to the payments on the Employer Billing Summary are not clearly listed. It is very important to completely and clearly list any changes to the Summary.
The primary malpractice carrier does not notify the Fund of physicians, CRNAs, or organizations to add or delete from a group bill. The provider or representative of the group must contact the Fund to set up a group bill and to add or delete providers to the bill.
Providers that do not pay the minimum amount due on the Fund's billing statement by the due date are in financial noncompliance. Actions taken by the Fund to achieve compliance include:
Letters are sent by Fund staff to alert the provider to noncompliant status and to request immediate payment.
If the provider fails to rectify his or her account balance, Fund staff will notify DSPS of noncompliant status.
Financial noncompliance letters are sent on the following time table:
- Bills are sent allowing 30 days for payment to reach the Fund.
- A noncompliance letter is sent by first class mail on the first day after payment is due (day 31).
- A certified letter is sent 15 days later if payment not received (day 45).
- A letter is sent to DSPS, giving notice of noncompliance if payment is not received within 30 days of the certified letter.
Section Ins 17.28 (k), Wis. Adm. Code, provides: "A provider shall pay at least the minimum amount due on or before each due date. If the Fund received payment later than the due date specified in the late payment notice sent to the provider by certified mail, the Fund may not apply the payment retroactively to the annual fee unless the board has authorized retroactive coverage."
The process for requesting retroactive coverage requires that the health care provider submit an affidavit to the Fund stating that he or she has no notice of any pending claim(s), threatened claim(s), or occurrence(s) that might give rise to a claim during the late period.
A provider may request coverage for a period of financial noncompliance by completing the Request for Retroactive Coverage – Financial. The form can be found on Noncompliance tab on the provider's page on the Fund's Public Access site.
If a health care provider does not resolve noncompliance financial issues, DSPS is notified and the Medical Examining Board may suspend or put a hold on the provider’s license.
The Fund Legal Committee reviews the petition for retroactive coverage and makes a recommendation to the Board of Governors to either approve or deny the request. The Board makes the final determination to approve or deny a retroactive coverage request.
Part-time and Half-time Rates
A provider may be eligible for coverage at a part-time rate if he or she practices fewer than 500 hours during the fiscal year. Practice must be limited to office practice and nursing home and house calls, and may not include obstetrics or surgery or assistance in surgical procedures.
A provider practicing 1,040 hours or less per fiscal year is eligible for a 40% reduction to their Fund fees. This half-time provider type does not include any of the restrictions that are in place for the part-time provider. Surgery, obstetrics, and hospital admitting privileges are all allowed under this classification.
Both part-time and half-time eligibility is based on cumulative hours of all work covered by the Fund.