Washington Administrative Code
Title 182 - Health Care Authority
WASHINGTON APPLE HEALTH
Chapter 182-550 - Hospital services
Section 182-550-7600 - OPPS payment calculation

Universal Citation: WA Admin Code 182-550-7600

Current through Register Vol. 24-18, September 15, 2024

(1) The medicaid agency calculates the enhanced ambulatory patient group (EAPG) payment as follows:

EAPG payment =

EAPG relative weight x

Hospital-specific conversion factor x

Discount factor (if applicable) x

Policy adjustor (if applicable)

(2) The total OPPS claim payment is the sum of the EAPG payments plus the sum of the allowed amounts for each non- EAPG service.

(3) If a client's third-party liability insurance has made a payment on a service, the agency subtracts any such payments made from the medicaid allowed amount.

11-14-075, recodified as §182-550-7600, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.500, and 2009-11 Omnibus Operating Budget (ESHB 1244). 09-12-062, § 388-550-7600, filed 5/28/09, effective 7/1/09. Statutory Authority: RCW 74.08.090, 74.09.500. 07-13-100, § 388-550-7600, filed 6/20/07, effective 8/1/07; 04-20-061, § 388-550-7600, filed 10/1/04, effective 11/1/04.

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