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By the Numbers

A monthly compendium of OHA finance and patient financial services policy and payment alerts


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ODH Issues Final Guidance on Schedule H Reporting

04/28/2017

HB 390 (ORC 3701.981) of the 131st General Assembly requires all tax-exempt hospitals to submit their community health needs assessments and improvement plans to the Ohio Department of Health. Additionally, tax-exempt hospitals are required to submit their IRS Schedule H (Form 990) and corresponding attachments to ODH on an annual b Read More . . .

ODM Delays Behavioral Health Redesign

04/28/2017

Following OHA’s March 9 webinar on behavioral health redesign, several member hospitals raised issues with what they heard, and the Ohio Department of Medicaid changed required redesign elements for hospitals. See the revised slide deck here. Specifically, those changes include delaying the termination of the 84 and 95 provide Read More . . .

2011 DSH Audit Recoupment Underway

04/28/2017

ODM on April 24 mailed recoupment letters to hospitals with dollars to be recouped according to the 2011 DSH Audit prepared by Myers and Stauffer. A sample letter can be found here. The letters were only sent to hospitals affected by this recoupment, so most will not receive a letter. If your hospital is one of those impacted, the r Read More . . .

340B Requirements Shifting

04/28/2017

ODM on April 17 withdrew rule 5160-1-17.11, Requirements for 340B Covered Entities, which in part required covered entities to include modifiers on outpatient claims with 340B drug lines where the hospital was seeking reimbursement for the drug provided. The rule also set ODM’s status reporting requirements for Ohio Medicaid p Read More . . .

Medicare FFY 2018 Inpatient PPS, LTCH PPS, Inpatient Psychiatric Proposed Rules Released

04/28/2017

CMS this month released its annual proposed rules to define its provider prospective payment systems. The proposals cover federal fiscal year 2018, the final rule is estimated to be published on Aug. 1 and will mostly go into effect Oct. 1. Comments will be accepted through June 13. OHA will hold a membership webinar on the proposed Read More . . .

CMS Social Security Number Removal Initiative Dates Set

04/28/2017

The Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, requires CMS to remove Social Security Numbers from all Medicare cards by April 2019 and CMS will respond with randomly generated Medicare Beneficiary Identifiers, starting this spring. Medicare identifiers will replace the Health Insurance Claim Number on Medicare Read More . . .

Just the Facts - April 2017

04/28/2017

An archive recording of the April 26 OHA Health Economics & Policy webinar Preparing for a Successful EAPG Implementation is available here.  A copy of the PowerPoint is here.  The April edition of the Ohio Bureau of Workers’ Compensation Provider e-News is available here and includes informatio Read More . . .

Hold the Dates - April 2017

04/28/2017

10 a.m. to noon, May 9 for OHA’s Health Economics & Policy Webinar on Medicare FFY 2018 Prospective Payment System Proposed Rules Overview. The registration link for this webinar can be found here. Encourage your our colleagues to the OHA 2017 Annual Meeting June 12-14 at the Columbus Hilton at Easton. Pa Read More . . .

CareSource Updates OHA Member Groups on Claim Reprocessing, Credentialing Delays, System Enhancements

04/28/2017

CareSource Vice President of the Ohio Market Operations Dan Hounchell on March 15 reported to OHA’s Admitting, Billing and Collection Committee and Large Provider Group that CareSource is committed to work on resolving outstanding payment recoupment issues, edit and denial challenges and unlinked/undocumented medical policies. Read More . . .

House Amends Hospital Budget Provisions, Adds Medicaid Work Requirements

04/28/2017

Ohio House Leadership on Tuesday revealed its proposed amendments to House Bill 49, the 2018-2019 state operating budget, which include changes to several hospital-related provisions. The House budget proposal cuts appropriation authority but freezes rates for hospitals, providing some stability for the next two years. In addition, Read More . . .

Hospital Executives Testify to HHS Finance Subcommittee Against State Budget Cuts, Non-Contracting Language

03/31/2017

A panel of health care executives testified March 22 before the Ohio House Finance Subcommittee on Health and Human Services against hospital payment cuts and non-contracting language proposed in House Bill 49, the 2018-2019 state operating budget.   The panel included member hospital executives Ray Chorey, president, Southea Read More . . .

Final Hospital Base Rates, EAPG Relative Weights, APRDRG Weights Released for July 1

03/31/2017

The Ohio Department of Medicaid has released the Hospital Base Rates, EAPG Relative Weights and APRDRG Weights for July 1, 2017. These have been vetted by ODM and the Medicaid managed care plans and are now ready for release. Please note that the relative weight table includes Average Length of Stay. The final document detailing all Read More . . .

SFY 2016 Cost Report Review Complete

03/31/2017

ODM has completed review of all in-state DRG and DRG-exempt hospital cost reports for SFY 2016, excluding psychiatric hospitals. Four hospitals with cost reports uploaded to the MITS portal March 28 have their 30-day window close April 28. After this, the final 30-day window will open for all hospitals and will close May 28.  Read More . . .

Requirements for 340B Covered Entities Delayed

03/31/2017

Ohio Department of Medicaid on March 6 withdrew rule 5160-1-17.11, requirements for 340B Covered Entities. In part, the rule required covered entities to include modifiers on outpatient claims with 340B drug lines where the hospital was seeking reimbursement for the drug provided. The rule also set ODM’s status reporting requi Read More . . .

MOON FAQs Posted Online

03/31/2017

The Centers for Medicare & Medicaid Services posted frequently asked questions concerning the Medicare Outpatient Observation Notice, or MOON. The MOON FAQs are available on the CMS website.    High level directives are offered on how hospitals should be completing the free-text fields on the form specifically to the Read More . . .

Identifiers to Replace Social Security Numbers

03/31/2017

The Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, requires CMS to remove Social Security Numbers from all Medicare cards by April 2019, and CMS will respond with randomly generated Medicare Beneficiary Identifiers, starting this spring. Medicare identifiers will replace the Health Insurance Claim Number on Medicar Read More . . .

CareSource Commits to Improved Claims Editing, Provider Credentialing

03/31/2017

Dan Hounchell, CareSource vice president of Ohio Market Operations, on March 15 reported to OHA’s Admitting, Billing & Collection Committee and Large Provider Group that CareSource is committed to resolving outstanding payment recoupment issues, edit and denial challenges and unlinked/undocumented medical policies. Hounche Read More . . .

AHA Meeting Provides Next Opportunity for ACA Discussion

03/31/2017

U.S. House Republican leaders last week canceled the planned vote on the American Health Care Act (H.R. 1628), legislation to repeal and replace parts of the Affordable Care Act.   The prospects of future congressional action addressing the ACA are uncertain at this time. The American Hospital Association annual meeting, tak Read More . . .

First Round of ADRs Distributed

03/31/2017

Performant Recovery, the recovery audit contractor, on March 23 sent the first round of ADRs to hospitals.   Performant Recovery, recently was awarded the RAC contract for Region One: Michigan and Indiana (J8 WPS MAC jurisdiction), Ohio and Kentucky (J15 CGS MAC jurisdiction) and New York, Vermont, New Hampshire, Maine, Massa Read More . . .

New VA Resources Available

03/31/2017

The Department of Veterans Affairs presented helpful resource materials for hospitals at the recent HFMA/American Association of Healthcare Administrative Management Conference in Akron. OHA has posted the following VA reference materials to our website for easy access: VA Rejection/Denial Reasons with Definitions VA App Read More . . .

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