Online CPR Certification Blog

Under the new federal law guidelines, providers will not be allowed to try recovering any money from beneficiaries of Medicaid, because they are actually on Medicaid and not that they are able to pay. As such, health care providers in the nation, especially hospitals are required to offer the service free of charge. The state legislature of Washington has been trying all possible ways of closing the worrying budget deficit using any means possible.

In this regard, they directed HCA to simply unnecessary expense in utilization of ER by nearly $72 million. At the start, HCA had tried to come up with a list comprising of various non- emergent medical diagnoses and directed that if any client went for ER visits more than 3 times to seek non- emergent diagnoses, any subsequent visit shouldn’t be paid for. In response to this, the healthcare community in Washington filed a lawsuit which successfully resulted in the rule being thrown away on procedural grounds. HCA lost the case because they didn’t follow the necessary public steps required when issuing such a rule.

HCA now doubles down after the suit

When everyone thought that the issue had finally been resolved, HCA on the other hand didn’t take this kindly and doubled down. Now, they have intentions of not paying for any kind of medical care in ER which after facts, they determine that it is non- emergence and the same kind of care could be provided in the normal office setting. They hoped to determine this by carrying out a retrospective medical review of coded diagnosis. In addition, unlike the past attempt to do this, this time, no one will be exempted from this including the children, state wards, patients referred to ER visits by their health care physician or those presenting through EMS. This new policy is expected to take effect during the first ER visit and not the third visit which is non- emergent.

The problem with the new policy

HCA decided not to follow the right procedure of the process of making public rules. In fact, they won’t apply for any State Plan Amendment through federal Center for Medicaid and Medicare services. According to them, they have the authority of deciding stopping payments for things which to their opinion weren’t emergencies. However, the truth is that this is problematic for many reasons. It is an undeniable fact that most Medicaid patients tend to abuse and overuse ER for complaints that aren’t acute or emergent. Well, most would argue that the state has finally come to terms with this and it is doing the best thing about it. However, the only set back about their policy is that it does nothing to ensure that the patients are out of ER. With the new policy, they will now be paying for nothing. And since most private doctors are not eager to accept these Medicaid patients at their offices, they will simply continue coming and providers of emergency will simply have to take care of them without being reimbursed.