Hospitals lose reimbursement for 'unnecessary' ER visits

Designed to curb the "overuse and abuse" of costly emergency care, Washington's hospitals will no longer receive Medicaid reimbursement for any "unnecessary" emergency room visits starting April 1, reported The Seattle Times.

In what could be the nation's most restrictive Medicaid ER policy, the program would stop payment for roughly 500 conditions, ranging from the obviously nonemergent diaper rash to the more complicated hypoglycemic coma and chest pain, the article noted.

Emergency physicians and hospitals would be left to foot the bill for treating those conditions.

But providers are urging lawmakers to halt the new policy, noting that Medicaid patients now will have to know what their diagnosis will be before going to the emergency department. "If we don't know without an X-ray or CT scan, how can they know it?" asked emergency physician Nathan Schlicher, legislative chairman of the Washington Chapter of the American College of Emergency Physicians.

Meanwhile, emergency departments at Utah hospitals are in hot water with the state's Medicaid program. They have allegedly overbilled Medicaid $22 million for charging emergency rates for non-emergency care between 2008 and 2009, reported The Salt Lake Tribune.

Utah's Medicaid inspector general has not revealed the hospitals in question and has yet to place some on official notice.

To learn more:
- read the Seattle Times article
- read the Salt Lake Tribune article

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