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 >>

Washington Hospital Services Industry Partner, Commerce Bank, helps member’s accounts payable department pay invoices on time and with accuracy. The time elapsed before payments are disbursed through highly manual processes, which cause all the moving parts to slow down and sets bill payments forward in slow motion, incurring additional costs along the way.... Read More >>

On November 20, WSHA provided hospitals with an analysis of the Calendar Year 2016 Medicare outpatient prospective payment system final rule. WSHA also provided facility-specific impact reports to hospital Chief Financial Officers. The new payment rates include a 2.1 percent market basket increase that is offset by an ACA-mandated reduction of 0.7 percent and an additional adjustment reduction of 2 percent due to lab services that should have been bundled being paid separately in error. ... Read More >>

Washington State Insurance Commissioner Mike Kreidler plans to submit proposed legislation in the upcoming 2016 session to limit balance billing of patients for out-of-network emergency services when a patient receives care at a facility contracted as in-network with their health plan.... Read More >>

The final rule for payment of early obstetrical deliveries adopted by the Washington State Health Care Authority (HCA) includes protections requested by WSHA for patients and providers. The rule is intended to deny Medicaid payment for early elective deliveries. The final rule allows payment for deliveries prior to 39 weeks if the early delivery is medically necessary.... Read More >>

On November 1, the Washington State Health Care Authority (HCA) reduced inpatient and outpatient hospital payments to prospective payment hospitals by 8 percent in order to apply budget neutrality adjustments due to the recent rebasing of the payment systems. In response to this significant change in Medicaid rates, WSHA requested HCA and its consultant, Navigant, review the calculations and provide WSHA with data sets to enable an independent analysis.... Read More >>

After several years of frustration and advocacy, hospitals should soon see meaningful reform to the Recover Audit Contractor (RAC) program. Effective January 1, the amount of audit requests RACs will be able to request for a hospital will be reduced by three-fourths, from 2.0 percent down to 0.5 percent of the hospital’s paid Medicare claims from the previous year.... Read More >>