Chapter 296-23A

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Chapter 296-23A

Hospitals
WAC Sections
Part 1	General Information
296-23A-0100	Where can I find general information and rules pertaining to the care of workers?
296-23A-0110	When will the department or self-insurer pay for hospital services?
296-23A-0120	What services are subject to review by the department or self-insurer?
296-23A-0130	How does the department establish hospital payment rates?
296-23A-0140	How can interested persons request advance notice of changes to hospital payment rates, methods and policies?

Part 1.1	Submitting Bills
296-23A-0150	How must hospitals submit bills for hospital services?
296-23A-0160	How must hospitals submit charges for ambulance and professional services?
296-23A-0170	How must hospitals bill the department or self-insurer for preadmission services?

Part 1.2	Supporting Documentation Requirements
296-23A-0180	What supporting documentation must hositals send for hospital services?
296-23A-0190	Where must hospitals send supporting documentation for hospital services for state fund claims?
296-23A-0195	When must providers using electronic medium submit supporting documentation?

Part 2	Payment Methods for Hospital Services
296-23A-0200	How does the department pay for hospital inpatient services?
296-23A-0210	How do self-insurers pay for hospital inpatient services?
296-23A-0220	How does the department pay for hospital outpatient services?
296-23A-0221	How does the self-insurer pay for hospital outpatient services?
296-23A-0230	How does the department or self-insurer pay out-of-state hospitals for hospital services?
296-23A-0240	How does the department define and pay a new hospital?
296-23A-0250	Does a change in hospital ownership affect a hospital's payment rate?

Part 2.1	Percent of Allowed Charges, Payment Methods and Policies
296-23A-0300	When do percent of allowed charges (POAC) payment factors apply?
296-23A-0310	What is the method for calculating percent of allowed charges (POAC) factors?

Part 2.2	Per Diem Rates Payment Methods and Policies
296-23A-0350	When do per diem rates apply?
296-23A-0360	What is the method for calculating per diem rates?

Part 2.3	Diagnosis Related Group Payment Methods and Policies
296-23A-0400	What is a "diagnosis-related-group" payment system?
296-23A-0410	How does the department calculate diagnosis-related-group (DRG) relative weights?
296-23A-0420	How does the department determine the base price for hospital services paid using per case rates?
296-23A-0430	How does the department calculate a hospital specific case-mix adjusted average cost per case?
296-23A-0440	How does the department calculate the base price for DRG hospitals, except major teaching hospitals?
296-23A-0450	What cases does the department exclude from base price calculations?
296-23A-0460	How does the department calculate the diagnosis-related-group (DRG) per case payment rate for a particular hospital?
296-23A-0470	Which exclusions and exceptions apply to diagnosis-related-group (DRG) payments for hospital services?
296-23A-0480	Which hospitals does the department exclude from diagnosis-related-group (DRG) payments?
296-23A-0490	Which hospital services does the department include in diagnosis-related-group (DRG) rates?
296-23A-0500	When does a case qualify for high outlier status?
296-23A-0520	How does the department pay for high outlier cases?
296-23A-0530	How does a case qualify for low outlier status?
296-23A-0540	How does the department pay for low outlier cases?
296-23A-0550	Under what circumstances will the department pay for interim bills?
296-23A-0560	How does the department define and pay for hospital readmissions?
296-23A-0570	How does the department define a transfer case?
296-23A-0575	How does the department pay a transferring hospital for a transfer case?
296-23A-0580	How does the department pay the receiving hospital for a transfer case?

Part 3	Requesting a Hospital Rate Adjustment
296-23A-0600	How can a hospital request a rate adjustment?
296-23A-0610	Where must hospitals submit requests for rate adjustments?
296-23A-0620	What 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-0700	What is the "ambulatory payment classification" (APC) payment system?
296-23A-0710	Definitions
296-23A-0720	How does the department calculate the hospital-specific per APC rate used for paying outpatient services under the outpatient prospective payment system (OPPS)?
296-23A-0730	How does the department determine the APC relative weights?
296-23A-0740	How does the department calculate payments for covered outpatient services through the outpatient prospective payment system (OPPS)?
296-23A-0750	What exclusions and exceptions apply to ambulatory-payment-classification (APC) payments for hospital services?
296-23A-0770	How will excluded outpatient services and hospitals be paid?
296-23A-0780	What information needs to be submitted for the hospital to be paid for outpatient services?

Hospitals

WAC Sections

Part 1

General Information

Part 1.1

Submitting Bills

Part 1.2

Supporting Documentation Requirements

Part 2

Payment Methods for Hospital Services

Part 2.1

Percent of Allowed Charges, Payment Methods and Policies

Part 2.2

Per Diem Rates Payment Methods and Policies

Part 2.3

Diagnosis Related Group Payment Methods and Policies

Part 3

Requesting a Hospital Rate Adjustment

Part 4

Ambulatory Payment Classification Payment Methods and Policies