Apple Health (Medicaid) Provider Alert
The Health Care Authority (HCA) published revised versions of the following billing guides, effective January 1, 2023:
Billing guide changes align with WAC updates that go into effect January 1, 2023. View the What has changed table in each guide for more information.
What has changed?
HCA amended Chapter 182-548 WAC Federally Qualified Health Centers (FQHC) and Chapter 182-549 WAC Rural Health Clinics (RHC) to clarify the change in scope and reconciliation policies, add an end date to align with the APM4 Memorandum of Understanding (MOU), create a new section on appeals, and other housekeeping changes.
Key Changes
- Revised the definition of “encounter” to include telehealth (including audio only telemedicine)
- Clarified new site/clinic enrollment documentation requirements
- Revised language for billing more than one encounter eligible service per day
- Added a new provision allowing prospective changes in scope to be submitted with less than 12 months of actual data in the cost report
- Updated the WAC reference for change in scope appeals
To see full detail of the WAC changes, visit the Washington State Legislature website, Chapter 182-548 WAC for FQHC updates and Chapter 182-549 WAC for RHC updates or access the formally proposed rule changes under WSR 22-22-049.
For questions regarding these changes, contact the FQHC or RHC Program.
|
