HCA Updates Billing Instructions for Hospital and Physician-Related Services

May 9, 2018

The Health Care Authority recently posted updated versions of its Medicaid billing guides for hospital and physician related services.  Billing staff will want to be aware of changes to billing requirements:
The Physician-Related Services Billing Guide:

  • New instructions regarding billing for services by resident physicians and clarification of the role of medical students (page 26);
  • Changes to services which must undergo a medical necessity review by Qualis Health, including Botulinum toxin (Botox) injections for treatment of chronic Migraine headaches (page 307), hysterectomies, other than for cancer or trauma meeting EPA criteria (page 123) and Varicose vein treatment (page 117);
  • Changes to documentation requirements for telemedicine services (page 88); and
  • Changes to Collaborative Care Guidelines specifying that clients must have a minimum of one face-to-face visit with the directing treating physician or other qualified health care professional every three months (page 58).

In addition, HCA has provided an update regarding payment for services to pregnant women and newborns to better coordinate payment through the managed care organizations and revised instruction beginning page 81 of the Inpatient Hospital Billing Guide. (Andrew Busz, andrewb@wsha.org)


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