PDFWAC 182-550-7000
Outpatient prospective payment system (OPPS)—General.
(1) The medicaid agency pays for outpatient services using an outpatient prospective payment system (OPPS) for all hospitals that do not qualify as in-state critical access hospitals per WAC 182-550-2598.
(2) The agency uses the enhanced ambulatory payment group (EAPG) software provided by 3MTM Health Information Systems to group OPPS claims based on services performed and resource intensity.
(3) The agency uses the group established in subsection (2) of this section to determine payment for OPPS claims.
[Statutory Authority: RCW 41.05.021 and chapter 74.60 RCW. WSR 14-14-049, § 182-550-7000, filed 6/25/14, effective 7/26/14. WSR 11-14-075, recodified as § 182-550-7000, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.500. WSR 07-13-100, § 388-550-7000, filed 6/20/07, effective 8/1/07; WSR 04-20-061, § 388-550-7000, filed 10/1/04, effective 11/1/04.]