News

The Health Care Authority has revised both its inpatient hospital and physician-related services provider billing guides to reflect changes to its policy regarding payment for elective early deliveries. Effective January 1, 2016, HCA will not pay for professional or hospital charges related to elective early deliveries before 39 weeks gestation, unless the physician documents that the early delivery is medically necessary. ... Read More >>

Under a federal law passed last summer, hospitals may need to provide written and oral notification to Medicare patients placed in observation status as early as August 2016. Unfortunately, the federal rulemaking process may leave little time for hospitals to implement the requirements once the specific requirements are known. The Centers for Medicare and Medicaid Services (CMS) has not yet released its proposed rule for comment.... Read More >>

The Health Care Authority has extended its deadline to February 1 for providers to apply to offer total joint replacements using bundled payments for its coverage for state employees. The proposal, based on the episode of care established by the Bree Collaborative, includes establishment of patient disability and failure of more conservative treatment, determination of fitness for surgery, use of evidence-based surgical practices, and standardized post-operative care.... Read More >>

Medicaid inpatient hospital payment rates for Washington hospitals paid on the prospective payment system now incorporate penalties based on “excessive” rates of hospital readmissions. A number of hospitals will see small reductions in payment because of this change – with penalties ranging from 0.0 percent to a maximum of 1.0 percent. The new policy from the Health Care Authority penalizes hospitals that appear to have an excessive number of potentially preventable admissions, based on an HCA analysis using 3M Corporation software.... Read More >>

On November 1, 2015 the Washington State Health Care Authority (HCA) made an 8 percent reduction in inpatient Medicaid payment rates. There appears to be material errors in the November calculation. As a result of questions that WSHA raised, HCA informed us it discovered an error in the inpatient calculation related to how it priced payments for certified public expenditure hospitals.... Read More >>

PeaceHealth Medical Group is offering free one-on-one weight loss counseling sessions to their Medicare patients to help battle obesity. The program, titled “Intensive Behavioral Therapy” (IBT), was developed by Medicare to help those with a body mass index (BMI) of 30 or higher keep their weight down. PeaceHealth is offering the service to all its patients with Medicare Part A or Part B coverage who are referred by their primary care provider.... Read More >>

Hospitals and health systems, health care practices, community-based organizations and others can apply until March 31 to participate in a new Center for Medicare and Medicaid Innovation model that will test whether access to health-related social services reduces health care costs and use of inpatient and outpatient health care services for Medicare and Medicaid beneficiaries, the Centers for Medicare & Medicaid Services announced Jan. 5.... Read More >>

The Washington Health Benefit Exchange has announced that nearly 174,000 Washington State residents have signed up for or renewed their health coverage as of Jan. 2. The deadline to select a Qualified Health Plan is Jan. 31 for coverage beginning March 1.... Read More >>

I was tickled to see the topic of hospital affiliations become a hot topic on the final season of Downton Abbey, despite the media poo-pooing (“Is the saga of the Downton Cottage Hospital the dullest plotline in TV history?” and “Downton Abbey's dreary hospital storyline a symptom of show's slow and painful death” and from the Guardian: “… Cousin Violet and Cousin Isobel are at war over something very tedious about a hospital”).... Read More >>

The affiliation between Virginia Mason and the Yakima-based Memorial Family of Services, which includes Yakima Valley Memorial Hospital, became official on Jan. 1 as expected. The affiliation — a non-cash transaction — became official following regulatory review, making Memorial Family of Services and Yakima Valley Memorial Hospital part of Virginia Mason. The organizations signed legal documentation for the affiliation in November.... Read More >>