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: May 14 Webinar

OHA’s Health Economics & Policy team and HMS on May 14 hosted a webinar, "Ohio Medicaid’s Integrity Auditor HMS." An archive recording of the webinar is available here along with a copy of the HMS presentation. Pease contact Shawn Stack with questions.    

Reminder of Ohio Medicaid Inpatient LARC Billing Process

Ohio Medicaid provides coverage for Long-Acting Reversible Contraceptives (LARCs) in the inpatient hospital setting immediately after a delivery or up to the time of the inpatient discharge for postpartum women, or at any time deemed medically necessary. LARC services are also covered by Ohio Medicaid when provided in an outpatient hospital or...

OHA Reminds Hospitals of Process to Report Insurance Coverage Changes to Ohio Medicaid

Providers should supply supporting documentation if the insurance coverage is still active or termed. A letter from the insurance carrier or screen print of online verification done by the provider by the insurance carrier. The fax number to submit the 6614 Form is located on the Ohio Department of Medicaid’s 6614 Form located here on the...

Court Rules HHS Gets 'First Crack' at Fixing 340B Cuts

A federal district court judge on May 6 ruled that the U.S. Department of Health and Human Services would get "first crack at crafting appropriate remedial measures" to the nearly 30 percent cuts to Medicare payments affecting certain hospitals that participate in the 340B Drug Pricing Program. He also held that, like the...

CMS Issues National Coverage Determination (NCD90.2) On Next Generation Sequencing (NGS)

Effective for claims with dates of service on or after March 16, 2018, CMS has determined that the evidence is enough to cover diagnostic laboratory tests that use NGS under specified conditions. CMS will cover such testing under the Medicare program for beneficiaries with recurrent, relapsed, refractory, metastatic cancer, or advanced stages...

CMS Announces Changes to the Laboratory National Coverage Determination (NCD) Edit Software for July 2019

In issuing MLN MM11224, CMS reminds physicians, providers and suppliers billing Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries of changes forthcoming to the laboratory NCD edit software.CR 11224 announces the changes that will be in the July 2019 quarterly release of the edit module for clinical...

ODM Publishes SFY 2019 Hospital Cost Report Software

ODM has published the SFY 2019 Hospital Cost Report Software. It is available here. Please contact Daniel Vielhaber with questions.

OHA Releases Brief on CMS Proposed FY 2020 Long Term Care Hospital Prospective Payment System Rule

The Centers for Medicare & Medicaid Services on April 23 released the display copy of the federal fiscal year 2020 proposed payment rule for the Medicare Long-Term Care Hospital Prospective Payment System. The proposed rule reflects the annual update to the Medicare fee-for-service LTCH payment rates and policies.  A copy of the...

OHA Releases Brief on CMS Proposed FY 2020 Skilled Nursing Facility Prospective Payment System Rule

The Centers for Medicare & Medicaid Services on April 19 released the federal fiscal year 2020 proposed payment rule for the Skilled Nursing Facility Prospective Payment System.  The proposed rule reflects the annual updates to the Medicare fee-for-service SNF payment rates and policies. A copy of proposed rule Federal...