State Auditor’s Office issues Health Benefit Exchange performance review

Pursuant to legislative direction, the State Auditor’s Office (SAO) recently issued a performance audit of the Washington Health Benefit Exchange’s costs and sustainability. The SAO found the exchange’s operating expenses to be reasonable, and that joining the federal health exchange program now would increase the exchange's overall costs. The SAO also found that the exchange has not been fully reimbursed for Medicaid services.... Read More >>

Apple Health paper claims submission practices changing

Effective October 2016, the Health Care Authority (HCA) will accept only electronic claims for Apple Health (Medicaid) services, except under very limited circumstances. Providers may seek approval to submit paper claims if they are in a temporary or long-term situation outside of their control that precludes submission of claims electronically.... Read More >>

Court ruling calls for improvements to long-term mental health care

Last Friday, frustrated Superior Court Commissioner Craig Adams issued a historic court opinion, ordering the state to start work immediately to improve the long-term mental health system and the capacity of Western State Hospital. The commissioner’s ruling does not just sound the alarm bell; it requires specific steps be taken. It also directs WSHA to be a partner in selecting a special master to oversee compliance with the court’s order.... Read More >>

InSight offers perspectives on minority mental health awareness

In support of raising awareness of the specific mental health challenges facing minority populations, Washington Hospital Services Industry Partner InSight shared several bulletins that they have produced on this topic.... Read More >>

WSHA Submits Comment Letter to Insurance Commissioner Regarding Prior Authorization Rule

WSHA recently sent the Office of the Insurance Commissioner (OIC) a comment letter and recommendations in response to the OIC’s request for comments related to health plan prior authorizations. The initial comment period ended June 17.... Read More >>

CMS Delays Requirement for “JW” Billing Modifier for Outpatient Drug Wastage

The Centers for Medicare & Medicaid Services (CMS) has delayed until January 1, 2017 a requirement that Medicare Part B providers bill the unused portion of a single use vial as a separate expense line with a “JW’ modifier. A copy of the revised notice from Noridian is here.... Read More >>

2017 DSH Applications due August 1, 2016

The Health Care Authority (HCA) has begun the application process for the SFY 2017 Disproportionate Share Hospital (DSH) program for hospitals other than those participating in the Certified Public Expenditures program. Hospitals applying for DSH funding must submit an initial application to HCA by August 1, 2016 to continue to be considered for 2017 DSH funds.... Read More >>

Medicare Provider Re-validation: Update Your Enrollment to Avoid Payment Delays!

The Centers for Medicare & Medicaid Services has begun a provider re-validation process to identify and update changes that have occurred since the provider’s original enrollment. This process includes both institutional providers, such as hospitals, and individual providers.... Read More >>

SUNRx Offers 340b Solutions!

Washington Hospital Services Industry Partner SUNRx, an Industry leader in the 340b prescription program, now offers variable pricing structures, which allows you to optimize your 340b program. The new pricing models include switch fee model pricing, which allows easier access to their solutions, which already boast the lowest pricing and the most compliant 340b program nationwide.... Read More >>

WSHA Comments to CMS Regarding Value-based Physician Payment

WSHA recently submitted comments on the Center for Medicare and Medicaid Service’s proposed rule regarding physician payment under the Medicare Access and CHIP Reauthorization Act (MACRA). The act replaces the current sustainable growth rates formula governing physician payment with a new structure that will adjust physician payments based on attainment of quality measures. ... Read More >>

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