News You Can Use

May 17, 2022

This is a publication to keep you informed of issues and events pertaining to the osteopathic profession in Washington State. We invite you to submit topics or articles of interest to your colleagues for consideration. Submissions may be emailed to executivedirector@woma.org

Public Comment of Proposed Hospital Patient Discharge (CHARS) Rules

On April 19, 2022, the Department of Health filed a proposal (WSR 22-09-069) to amend existing rules and create new rules in chapter 246-455 WAC, Hospital Patient Discharge Information Reporting.

The proposed rules prescribe new reporting standards for patient information related to race, ethnicity, gender identity, sexual orientation, preferred language, and disability.

The proposed rules also establish a waiver process; strengthen protections of patient health care information to align with federal law changes; clarify and add requirements for data collection and reporting; establish formalized procedures for requesting hospital patient discharge data; prescribe direct and indirect patient identifiers; update or add definitions; make technical updates and clarifications to existing rules, and establish fees for data files and analysis.

The Department is accepting comments on the proposal rule until 5:00 p.m. on Tuesday, May 24, 2022.

1. You may submit written comments in three ways.

a. Online on the Rules Comment (wa.gov) site

(This will open the online comment site.)

b. Email to: Katitza.Holthaus@doh.wa.gov

c. U.S. Mail to:

Washington State Department of Health

Attn: Katitza Holthaus

PO Box 47814

Olympia, WA 98504-7814

2. You may also provide testimony on May 24, 2022, at 11 a.m.

To register for the virtual public hearing click on the Webinar Registration - Zoom link.

Increasing Claims Denials for OMT from Regence BlueShield

In recent weeks, several of our members have contacted WOMA concerned with significant claims denials they are receiving from Regence Blue Cross/Blue Shield when physicians are billing for osteopathic manipulative treatment. This is a frustrating turn of events, as several of our members have been billing Regence for OMT service without difficulty for years - using the office E&M code plus the “-25” modifier with the appropriate OMT CPT code. Here is what I have been able to gather so far on this matter.

In late November 2021, Regence rolled out a new computer and workflow system that gets very granular and literal with coding guidelines; they have a team of nurses with certification training that are going through and denying the office E&M code (e.g., “99213”) when combined with a “-25” modifier and the OMT CPT code. Their reasoning for this is that a patient cannot have OMT again within a 90-day window for the “same problem,” and thus they are denying the office E&M code and only paying for the OMT CPT code. Obviously, this reasoning is flawed and assumes that OMT is being performed as a surgical procedure, which is obviously not the case.

Moving forward, I recommend you work with your billing specialists to accurately code your visits and try to describe whether your patient has a new complaint or symptom(s) that you are evaluating, and then choosing to treat with OMT. The biggest push-back so far is with patients coming in to be re-evaluated – Regence feels the re-evaluation is not worthy of an office E&M code, only an OMT CPT code.

The AOA has a nice summary of recommendations for successful billing; I recommend you follow these guidelines if you are not already: https://osteopathic.org/practicing-medicine/business-of-medicine/osteopathic-billing-coding/

I will write to Regence with our concerns, given that they are misconstruing what OMT is in my opinion. This letter will be written as an open letter, and we will share this with the membership when it is sent to Regence.

Yours Osteopathically,

David M. Escobar, DO, MPH, FAAFP

President

Washington Osteopathic Medical Association

New Adult Immunization Recommendations

New Adult Immunization Recommendations: Hepatitis B, PCV, and Shingrix Dose 1

The Centers for Disease Control (CDC) recently updated adult vaccine recommendations related to hepatitis B vaccine, pneumococcal vaccine, and Shingrix.

Hepatitis B vaccine is now recommended for all adults aged 19-59 years regardless of risk factors, and anyone 60 years or older with risk factors. Hepatitis B vaccine may also be offered to all adults 60 years and older who wish to be vaccinated. PreHevbrio (VBI) is a new trivalent hepatitis B vaccine licensed in 2021 for use in adults age 18 or older as a 3-dose series given over 6 months.

Pneumococcal vaccines are recommended for all adults aged 65 years or older as well as adults aged 19-64 with certain underlying medical conditions or other risk factors. The new guidelines for PCV15, PCV20, and PPSV23 are listed in the table below as well as in the Adult Pneumococcal Vaccine Administration algorithm.

The new Shingrix vaccine guidelines recommend that two doses be given for all adults aged 19 years or older who are immunocompromised or have other risk factors.

Below is a more detailed summary of the updated recommendations with additional resources.

Adult PCV Recommendations 2022.pdf

New Adult Immunization Recommendations_Final.pdf

If you have any questions please contact Nicole Rhodes at nicole.rhodes@doh.wa.gov .

ESSB 5229 DOH

Health Equity Rules Workshop #4

May 23, 2022 1pm-3pm

The Department of Health (DOH) held a series of listening sessions and rules workshops to implement Engrossed Substitute Senate Bill (ESSB) 5229. ESSB 5229 directs DOH to create minimum standards for health equity continuing education that health professionals must take.

Final Rule Workshop

Zoom Meeting Info:

Topic: 5229 Rules Workshop

Time: Monday May 23, 2022 – 1:00pm – 3:00pm

Join Zoom Meeting

https://us02web.zoom.us/j/88657929022?pwd=VTlPdUpLajI1SHBkenZnaEJ6U3dWUT09

Meeting ID: 886 5792 9022

Passcode: 167288

DOH will hold its final rule workshop on May 23, 2022. This meeting will begin at 1pm and end at 3pm. They will review the current draft and relevant comments. To clarify from the previous rules workshop, the minimum standards in the health equity continuing education rules will apply to professions regulated by boards and commissions, as well as professions regulated by the Secretary of Health.

The DOH thanks those who have continued to provide experiences related to inequities in the health care system via written comment. They also thank those who have provided written comments throughout the rules workshop process.

The workshop will be held virtually on the Zoom platform at the below date and time.

Monday, May 23rd, 2022: 1PM – 3PM

If you have questions or would like to provide written comments, please contact us at healthequityimplementation@doh.wa.gov.

Attachments:

Agenda- 5229 - Meeting Agenda - Workshop 4.pdf

Draft Rules- Draft 5 - Health Equity Rule.pdf

Draft Rule Comments- 4th draft rule comments.pdf

PowerPoint- 5229 Workshop 4 Presentation - PowerPoint.pdf

Bill language- 5229-S.PL.pdf

Zoom Meeting Info:

Topic: 5229 Rules Workshop

Time: Monday May 23, 2022 – 1:00pm – 3:00pm