Office of the Insurance Commissioner Releases Prior Authorization Stakeholder Draft

On September 23, the Office of the Insurance Commissioner (OIC) released a third iteration of stakeholder draft rules concerning prior authorizations. We are pleased that the OIC has undertaken a rule making process on prior authorization and is trying to provide more transparency around some of the requirements.... Read More >>

HCA Working on New Data Sharing Requirements; WSHA Engaged in Discussions on Implementation

Starting February 1, 2017, all Medicaid contracted hospitals and providers will be required to participate in Washington’s new clinical data sharing program, called Link4Health. Link4Health is a Health Care Authority (HCA) initiative that will require providers who care for Medicaid patients to share certain clinical records electronically with HCA via a clinical data repository.... Read More >>

CMS to Finalize Medicare Observation Notification Form

WSHA is in the process of preparing materials to help member hospitals meet federal observation notification requirements.... Read More >>

WSHA Working on Post-Acute Care Discharge Issues

Many hospitals are struggling with significant numbers of patients who have completed their acute hospital stay, but for whom post-hospital placement cannot be found. This ties up acute care beds in hospitals that are already running at or near capacity. ... Read More >>

Health Care Authority Updates Payment Rules Governing FQHC and Rural Health Clinic Payment

The Washington Health Care Authority (HCA) recently released proposed changes to the payment rules governing Medicaid payment to federally qualified health centers (FQHCs) and rural health clinics. The changes are intended to accommodate a new alternative payment model (APM) which HCA plans to pilot with a group of interested clinics effective January 1, 2017. ... Read More >>

Washington Hospitals Expected to Lose $20 Million in Medicare Inpatient Update

The Centers for Medicare & Medicaid Services recently released its final rule for inpatient prospective payment system rates. Compared to a total of $2.12 billion in inpatient payments for 2016, Washington hospitals are estimated to receive $2.10 billion in 2017. ... Read More >>

Meridian Leasing Offers Insight into Achieving XR-29 CT Radiology Compliance

In April of 2014, the Protecting Access to Medicare Act was signed into law. Part of the law stated that the outpatient and physician reimbursement for certain diagnostic CT scans will be reduced by 5 percent in 2016 and a further 15 percent in 2017 if a CT system is not compliant with XR-29 guidelines.... Read More >>

340B Hospital Recertification Open through September 7. Have You Recertified?

The Health Resources and Services Administration's (HRSA) 340B hospital recertification process for 2016 continues through Sept. 7. All 340B hospitals must recertify with HRSA annually to ensure they continue to meet the 340B hospital eligibility requirements. ... Read More >>

Hospital Safety Net Revisions for FY 2017

With the start of the new state fiscal year there have been some changes to the hospital safety net program. Working with WSHA, the Health Care Authority has reset the assessment amounts for the new fiscal year. ... Read More >>

Bree Collaborative Considers Prior Authorization Standard Model

The Bree Collaborative, a Governor-appointed group of public and private partners working to improve health care quality, outcomes and affordability, is considering prior authorization as one of its focal points for the upcoming year. ... Read More >>

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