Chapter 296-23A WAC

Last Update: 4/3/07

HOSPITALS

WAC Sections

PART 1 - GENERAL INFORMATION
296-23A-0100Where can I find general information and rules pertaining to the care of workers?
296-23A-0110When will the department or self-insurer pay for hospital services?
296-23A-0120What services are subject to review by the department or self-insurer?
296-23A-0130How does the department establish hospital payment rates?
296-23A-0140How can interested persons request advance notice of changes to hospital payment rates, methods and policies?
PART 1.1 - SUBMITTING BILLS
296-23A-0150How must hospitals submit bills for hospital services?
296-23A-0160How must hospitals submit charges for ambulance and professional services?
296-23A-0170How must hospitals bill the department or self-insurer for preadmission services?
PART 1.2 - SUPPORTING DOCUMENTATION REQUIREMENTS
296-23A-0180What supporting documentation must hospitals send for hospital services?
296-23A-0190Where must hospitals send supporting documentation for hospital services for state fund claims?
296-23A-0195When must providers using electronic medium submit supporting documentation?
PART 2 - PAYMENT METHODS FOR HOSPITAL SERVICES
296-23A-0200How does the department pay for hospital inpatient services?
296-23A-0210How do self-insurers pay for hospital inpatient services?
296-23A-0220How does the department pay for hospital outpatient services?
296-23A-0221How does the self-insurer pay for hospital outpatient services?
296-23A-0230How does the department or self-insurer pay out-of-state hospitals for hospital services?
296-23A-0240How does the department define and pay a new hospital?
296-23A-0250Does a change in hospital ownership affect a hospital's payment rate?
PART 2.1 - PERCENT OF ALLOWED CHARGES (POAC)
PAYMENT METHODS AND POLICIES
296-23A-0300When do percent of allowed charges (POAC) payment factors apply?
296-23A-0310What is the method for calculating percent of allowed charges (POAC) factors?
PART 2.2 - PER DIEM PAYMENT METHODS AND POLICIES
296-23A-0350When do per diem rates apply?
296-23A-0360What is the method for calculating per diem rates?
PART 2.3 - DIAGNOSIS-RELATED-GROUP PAYMENT METHODS AND POLICIES
296-23A-0400What is a "diagnosis-related-group" payment system?
296-23A-0410How does the department calculate diagnosis-related-group (DRG) relative weights?
296-23A-0420How does the department determine the base price for hospital services paid using per case rates?
296-23A-0430How does the department calculate a hospital specific case-mix adjusted average cost per case?
296-23A-0440How does the department calculate the base price for DRG hospitals, except major teaching hospitals?
296-23A-0450What cases does the department exclude from base price calculations?
296-23A-0460How does the department calculate the diagnosis-related-group (DRG) per case payment rate for a particular hospital?
296-23A-0470Which exclusions and exceptions apply to diagnosis-related-group (DRG) payments for hospital services?
296-23A-0480Which hospitals does the department exclude from diagnosis-related-group (DRG) payments?
296-23A-0490Which hospital services does the department include in diagnosis-related-group (DRG) rates?
296-23A-0500When does a case qualify for high outlier status?
296-23A-0520How does the department pay for high outlier cases?
296-23A-0530How does a case qualify for low outlier status?
296-23A-0540How does the department pay for low outlier cases?
296-23A-0550Under what circumstances will the department pay for interim bills?
296-23A-0560How does the department define and pay for hospital readmissions?
296-23A-0570How does the department define a transfer case?
296-23A-0575How does the department pay a transferring hospital for a transfer case?
296-23A-0580How does the department pay the receiving hospital for a transfer case?
PART 3 - REQUESTING A HOSPITAL RATE ADJUSTMENT
296-23A-0600How can a hospital request a rate adjustment?
296-23A-0610Where must hospitals submit requests for rate adjustments?
296-23A-0620What action will the department take upon receipt of a request for a rate adjustment?
PART 4 - AMBULATORY PAYMENT CLASSIFICATION PAYMENT METHODS AND POLICIES
296-23A-0700What is the "ambulatory payment classification" (APC) payment system?
296-23A-0710Definitions.
296-23A-0720How does the department calculate the hospital-specific per APC rate used for paying outpatient services under the outpatient prospective payment system (OPPS)?
296-23A-0730How does the department determine the APC relative weights?
296-23A-0740How does the department calculate payments for covered outpatient services through the outpatient prospective payment system (OPPS)?
296-23A-0750What exclusions and exceptions apply to ambulatory-payment-classification (APC) payments for hospital services?
296-23A-0770How will excluded outpatient services and hospitals be paid?
296-23A-0780What information needs to be submitted for the hospital to be paid for outpatient services?
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