On January 20, House Bill 2447 Emergency Balance Billing was heard by the House Health Care & Wellness Committee. The bill, requested by the Office of the Insurance Commissioner, is intended to protect patients from unexpected charges in cases where they receive emergency care at a hospital that is contracted with their health insurer, but not all physicians providing professional services are contracted with that plan.... Read More >>

As reported in a recent WSHA bulletin, the Washington State Health Care Authority (HCA) has agreed to increase inpatient rates for the next quarter by about 18 percent. This restores errors it made to the budget neutrality adjustment factor (BNAF) rates during the last two quarters for Prospective Payment System hospitals and Certified Public Expenditure hospitals.... Read More >>

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 >>

WSHA gave a fond farewell to two retiring member hospital Chief Financial Officers at its recent meeting of the WSHA Chief Financial Officer Advisory Group. ... Read More >>

The Centers for Medicare and Medicaid Services (CMS) recently finalized its rule concerning the Comprehensive Care for Joint Replacement (CJR) program. The program will make hospitals that provide lower joint replacement surgeries in specified geographic areas financially responsible for costs related to an episode of care, including post-acute services. ... Read More >>

On December 4, the Washington Office of the Insurance Commissioner (OIC) sent interested stakeholders, including WSHA, draft legislation concerning balance billing for services by a provider who is not contracted with a patient’s health plan, when the services are provided at a contracted hospital. ... Read More >>