State Workgroup Considers Hospital Cuts to Offset Medicaid Managed Care Rate Increases

The State’s Health Care Oversight Joint Select Committee met last Wednesday to hear an update on a study looking at ways to deliver a zero increase rate for Medicaid managed care plans in the upcoming fiscal year. Staff from the Health Care Authority recommended three areas of focus based on the recommendations from its workgroup, composed of state staff and the managed care plans.... Read More >>

Webcasts July 26 on how MACRA changes how physicians are paid

WSHA will host two webcasts on July 26 detailing how the Medicare Access and CHIP Reauthorization Act (MACRA), which was passed by Congress in 2015, fundamentally changes how physicians are paid. WSHA will offer separate webcasts for critical access hospitals (8-9:30 a.m.) and non-critical access hospitals (12-1:30 p.m.).... 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 >>

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 >>

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