Finance News

Finance News web alerts provide timely updates on federal and state reimbursement policies and procedures for hospitals and health systems.

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Archive Copy: March 19 Hospital Outreach Laboratories Webinar

OHA’s Health Economics & Policy team and Bricker & Eckler LLP on March 19 hosted a webinar, "Medicare Clinical Lab Fee Reporting Requirements for Hospital Outreach Laboratories." An archive recording of the webinar is available here long with a copy of Bricker & Eckler’s presentation. Please contact Shawn...

Ohio Medicaid’s Program Integrity Auditor Requests Medical Records for First Retro-Review Project

Permedion/HMS on March 19 issued the first batch of retro-review medical record requests to Ohio Hospitals. If electronic protocols have not yet been established with your hospitals, please submit medical records hard copy to:                 HMS   ...

CMS Approves Ohio Medicaid Waiver with Work Requirement

The Centers for Medicare & Medicaid Services on March 15 approved a Section 1115 waiver for Ohio that will require certain adults aged 19 to 49 to work or participate in training or community service for at least 80 hours per month to continue qualifying for Medicaid. The state expects the implement the demonstration on Jan. 1, 2021. Ohio is...

MACPAC Recommends Phasing in Medicaid DSH Cuts, Restructuring Allotments

The Medicaid and CHIP Payment and Access Commission on Friday released its March 2019 report to Congress, which recommends Congress phase in the Affordable Care Act's Medicaid Disproportionate Share Hospital reductions over a longer period and restructure the DSH allotment methodology based on the number of low-income individuals...

Reminder: Use Dental Codes for Proper Medicaid Reimbursement

The Ohio Hospital Association reminds member hospitals to ensure they are billing dental services to Ohio Medicaid using the EAPG covered dental codes to receive appropriate reimbursement. Through claims data analysis, OHA and BKD saw a vast under-reporting of D-Codes (Dental Codes) on hospital outpatient claims. Hospital are urged to bill...

New Guidance Released for CMS Section 1115 Demonstrations

The Centers for Medicare and Medicaid Services on March 14 released updated guidance and tools that provide direction on standard monitoring metrics and recommended research methods for Section 1115 demonstrations. Section 1115 demonstrations allow states to test new policy approaches such as work requirements, premium assistance to...

CMS Updates Drug Dashboards with Prescription Drug Pricing and Spending Data

The Centers for Medicare & Medicaid Services today updated its Drug Spending Dashboards with data for 2017. The Trump Administration’s version of the drug dashboards, first released in May of last year, adds information on the manufacturers that are responsible for price increases and includes pricing and spending data for thousands...

CMS Requests Feedback on Selling Health Coverage Across State Lines

The Centers for Medicare & Medicaid Services this week requested input on how to enhance insurers' ability to sell individual health insurance coverage across state lines. Questions in the request for information focus on expanding access to health insurance across state lines, operationalizing the sale of health insurance across state...

Reminder: Medicare Member Location Addresses on Claims Must Match PECOS Records by April 1, 2019

Ohio’s Medicare Administrative Contractor, CGS, confirmed today to OHA that edits will be engaging on April 1 verifying that off-campus, outpatient, provider-based department location addresses on claims must match exactly the address that has been provided and updated to CMS’ PECOs system.   CMS must begin to...