January 27, 2010
- Safety Net Assessment Information Distributed
- WSHA Reviews Emergency Provider Bills
- HRSA Expands Testing Opportunities for ProviderOne
- AHA Provides New Information on the Recovery Audit Contractor Program
- The 2010 Census is Coming!
- Correction to Previous Fiscal Watch
Safety Net Assessment Information Distributed
WSHA's Hospital Safety Net Assessment proposal is moving through the Washington State Legislature. The legislation—House Bill 2956—has been introduced as Governor's request legislation and is sponsored by Representative Eric Pettigrew. Information about the bill, including a summary, is posted on the WSHA website at www.wsha.org.
The assessment will shore up the hospital safety net and mitigate the bulk of the Medicaid cuts made during the last legislative session. We believe it will also help prevent future cuts to the Medicaid program and protect the Critical Access Hospital program. In total, hospitals will receive about $200 million in increased Medicaid payments from the assessment this biennium, as well as significant increases in the next biennium. The money is essential to preserve vital health services for Medicaid and Apple Health for Kids enrollees.
WSHA has mailed information to hospital CEOs and CFOs, including the total impact on all hospitals and the specific impact on each hospital and health system. Included in the CFO mailing is technical information on how the estimates were developed. If you have questions, please contact Andrew Busz at andrewb@wsha.org or 206-216-2533, or Claudia Sanders at claudias@wsha.org or 206-216-2508. (claudias@wsha.org)
WSHA Reviews Emergency Provider Bills
Several bills recently introduced in the legislature seek to help protect patients from unexpected high out-of-pocket expenses when they have used a hospital emergency room. At issue is the fact that insured patients who use an in-network emergency hospital can end up paying out-of-network expenses for physicians. This happens in cases where the physician providing the emergency service is not a contracted physician from the insurance plan.
Several bills seek to remedy this situation by requiring the physicians to accept a certain specified rate for their services and requiring the plans to pay at that rate.
WSHA has expressed opposition to the bills because of our concern about their implications downstream for finding physicians who are willing to accept call coverage. If the pre-set rate is too low to compensate the physicians, they may be more reluctant to accept call. If the pre-set rate is too high, there may be incentives for them to refuse to contract with the plans.
It is still unclear if there will be a legislative solution to this issue during this session. (andrewb@wsha.org)
HRSA Expands Testing Opportunities for ProviderOne
WSHA has been working cooperatively with the Health and Recovery Services Administration (HRSA) to ensure that ProviderOne, the new management information system, will appropriately process claims on a timely basis when it is implemented. The system, originally scheduled for implementation in January, was delayed in order to ensure a smoother transition. The implementation date is now scheduled for April.
In order to help hospitals get ready for the transition, WSHA will present a web cast in early February on how hospitals can best ensure a smooth transition. The web cast will allow hospitals to learn from those hospitals that have been most successful in working their way through transition issues. WSHA will be sending a web cast announcement with the date and time next week.
Meanwhile, at the suggestion of WSHA and several hospitals, HRSA has provided expanded opportunities for hospitals to test their claims system to ensure they are set for the transition. HRSA announced the details on their new testing environment recently. Hospitals can now submit their own claims information and test direct data entry and HIPPA batch file transactions, including claim status and receipt of electronic remittance advice, in a production environment prior to system implementation. The testing environment will be available for the next three months. Because claims submission acceptance and results verification can take a month or more, hospitals should begin this process as soon as possible to ensure their claims will pay under the new system.
HRSA is also expanding its live call center (1-800-562-3022 option 2, then 4) to help providers get set up on the ProviderOne system. Updated copies of ProviderOne’s Bi-Weekly Progress Brief and Status Report showing each facility’s registration status are posted in the ProviderOne section of the WSHA website. We urge each hospital to verify that each of their active entities (assigned National Practitioner Identification numbers) have successfully completed security and registration and are beginning the claims testing process. (andrewb@wsha.org)
AHA Provides New Information on the Recovery Audit Contractor Program
On January 11, the American Hospital Association (AHA) produced an update on the Medicare Recovery Audit Contractor (RAC) program. RACs are auditing firms contracted by the Centers for Medicare and Medicaid Services to identify overpayments on Medicare claims. RACs are paid a contingency percentage of the recovered payments. Among other information, the update includes the anticipated roll-out dates for the various types of RAC audits.
Additional information regarding the RAC program can be found on WSHA’s RAC web page. WSHA also has a listserv for hospitals to share RAC-related information. (andrewb@wsha.org)
The 2010 Census is Coming!
The 2010 Federal Census will begin in February 2010. At that time, the U.S. Census Bureau will begin contacting hospitals, skilled nursing facilities, and inpatient hospice facilities to count certain patients in the facility instead of in the patients’ homes. Some hospitals may elect self-enumeration, where census information for patients is collected by hospital staff rather than census bureau employees. Alcohol and drug treatment centers are subject to specific rules protecting the identity of patients in those centers.
The American Hospital Association has issued a Regulatory Advisory describing the census process and procedures to be followed by hospitals and other inpatient facilities. (andrewb@wsha.org)
Correction to Previous Fiscal Watch
Our previous Fiscal Watch incorrectly stated Medicare Advantage private fee-for-service plans must have contracted networks beginning 2010. The correct date for the network contracting requirement is 2011. Private fee-for-service plans must report quality information to CMS beginning 2010.
Providers, hospitals and potential Medicare enrollees can look up which plans are available in their region on the CMS Plan Finder and determine current enrollment of the plans in their region by referring to county-specific data. January 2010 enrollment information should be available in the next few weeks. (andrewb@wsha.org)