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 >>

WSHA Comments to OIC Regarding Prior Authorizations

On June 28, WSHA testified at a meeting convened by the Office of the Insurance Commissioner (OIC) regarding potential rulemaking on health plan prior authorizations. In its comments WSHA requested that OIC require plans to make available to providers criteria used to determine medical necessity for prior authorizations and better integrate authorizations provided through plan-contracted benefit managers and other entities.... Read More >>

HCA to Reprocess Outpatient Hospital Claims

The Health Care Authority (HCA) has advised WSHA that a number of outpatient hospital claims paid through the ProviderOne system over the last six weeks were paid at incorrect grouper weights rates and will be reprocessed though a mass adjustment process. The payment error was made as HCA began to prepare for a July 1st update to its outpatient Enhanced Ambulatory Payment Group (EAPG) payment system. ... Read More >>

WSHA Submits Comment Letter to Insurance Commissioner Regarding Prior Authorization Rule Changes

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 OIC is considering rulemaking to streamline the prior authorization process and make it easier for consumers and providers to get prior authorizations.... Read More >>

Para HealthCare Provides Information on “JW” Billing Modifier for Outpatient Drug Wastage

The Centers for Medicare and Medicaid Services made a change, effective July 1, 2016 requiring Medicare Part B providers to bill on a separate expense line with a “JW’ modifier, any unused portion of a single use vial or package. Washington Hospital Services Industry Partner, Para HealthCare, has provides a helpful article detailing the new requirements.... Read More >>

WSHA Provides Analyses of Proposed Medicare Inpatient PPS, Inpatient Rehab, and Skilled Nursing Facility Rule, Wage Index Data

WSHA recently produced and sent analyses of several recent proposed Medicare rules issued by CMS along with hospital-specific impact reports to the Chief Financial Officer and/or other designated finance persons for each facility. This information is to help hospital finance leader understand the impacts of the various rules on your hospitals.... Read More >>

Insurance Commissioner Considering Rule Changes for Prior Authorizations: Your Input Needed!

In response to provider and enrollee concerns, the Office of the Insurance Commissioner (OIC) announced it is considering rule-making to provide more specific requirements related to health plan prior authorizations. The rules would provide make the prior authorization process more predictable and transparent, and they would minimize the burden of the process on consumers.... Read More >>

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