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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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OHA Publishes Most Commonly Denied Medicaid Non-Covered Codes

10/31/2018

OHA has been working with the Ohio Department of Medicaid’s Hospital Policy Team to develop a list of commonly billed non-covered outpatient codes. As a part of OHA’s continued outreach and education, here is a list of the most commonly billed non-covered outpatient codes and corresponding comments OHA has created t Read More . . .

Update: ODM Addressing Inappropriate Denials for Invalid NDC/HCPCS

10/31/2018

The Ohio Department of Medicaid’s Hospital Policy Team reported to OHA that, due to an oversight, edit 4891, Invalid NDC/HCPCS combination, was returned to a deny status effective Oct. 1. ODM is planning an emergency update to have the denials returned to pay/post status prior to that date.ODM confirmed on Oct. 15 that the eme Read More . . .

Member Hospitals Encouraged to Join County Stepping Up Initiative

10/31/2018

The OHA Behavioral Health Leadership Council in 2017 set a priority to work with law enforcement and the judicial system to understand the roles of these stakeholders in the bigger picture of behavioral health care in Ohio. In researching this topic, OHA joined Ohio’s Stepping Up initiative. Stepping Up is part of a natio Read More . . .

ODM Updates Quality Metrics

10/31/2018

Reports have been delayed for an unspecified amount of time for latest round of episode-based payments, but the Ohio Department of Medicaid hosted a webinar on Oct. 23 and shared some design updates, largely in the quality metrics. At this point, there are nine episodes tied to payment:   EpisodePrincipal Accountable Pro Read More . . .

OHA President Expresses Concerns About Site-Neutral Policies, AHA Launches Ad Campaign

10/31/2018

OHA President and CEO Mike Abrams, in a letter to the editor, on Oct. 12 detailed the hospital community’s concern about the Centers for Medicare & Medicaid Services' proposal to expand certain payment policies in 2019 that could harm access to care, particularly for the most vulnerable, by cutting $51 millio Read More . . .

CMS Releases FAQ on New Transparency Requirement

10/31/2018

The Centers for Medicare & Medicaid Services recently expanded on new health care price transparency requirements for hospitals in a series of frequently asked questions  published on its website. The FAQs cover which hospitals are subject to the new requirements, the definition of machine-readable, and what items and serv Read More . . .

ODM Announces SFY 2019 Hospital Franchise Fee, UPL Payment Schedules

10/31/2018

The Ohio Department of Medicaid has set dates for hospital assessments and supplemental Medicaid upper payment limit, or UPL, payments for SFY 2019: 1st Assessment: Oct. 29 1st Payment: Nov. 12 2nd Assessment: Jan. 14, 2019 2nd Payment: Jan. 28, 2019 3rd Assessment: Feb. 25, 2019 3rd Payment: March 11, 2019 4th Assessment: Ap Read More . . .

Medicare Enrollment Opens Oct. 15

10/31/2018

Open enrollment for Medicare runs Oct. 15 through Dec. 7. For consumers who choose a new Medicare Advantage or Part D plan, that new coverage will begin on Jan. 1, 2019. Here is a helpful consumer site if hospitals need reference materials for staff training. Please contact Shawn Stack with questions. Read More . . .

New Medicare Card Mailing Update — Ohio in Current Wave

10/31/2018

CMS several weeks ago started mailing new Medicare cards to people with Medicare who live in Wave 7 states and territories including: Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Puerto Rico, Tennessee and the Virgin Islands. CMS concluded mailing cards to people with Medicare who live in states within Waves 1 throug Read More . . .

CMS Reports Exchange Premiums Drop for 2019

10/31/2018

The Center for Medicare & Medicaid Services on Oct. 11 reported average premiums for silver plans dropped 1.5 percent for 2019, the first-time premiums have fallen since the implementation of the Exchange Plans in 2014.   The full CMS announcement can be accessed here. Read More . . .

CMS Publishes CHIP Provisions

10/31/2018

CMS on Oct. 5 published a summary of key provisions of the HEALTHY KIDS and ACCESS Acts that are related to the Children’s Health Insurance Program, or CHIP, as well as other children’s  coverage and quality provisions. Congress in March extended funding for CHIP through Sept. 30, 2027.   Included are details Read More . . .

CMS Omnibus on Burden Reductions Proposed Rule

10/31/2018

Join the Centers for Medicare & Medicaid Services for a tri-region webinar hosted by the chief medical officer of regions V, VI and VII. Content is the same for both webinars and will discuss changes in the Omnibus proposed rule and will include a question-and-answer session. Registration is required. 2-2:23 p.m. (ET) Read More . . .

Call to Action: Pledge Support of 340B Stewardship Principles

10/31/2018

Leaders from the American Hospital Association and the AHA Advocacy Alliance for the 340B Drug Pricing Program have announced new principles for ensuring good stewardship of the 340B program and request member hospitals pledge to join the effort. This new AHA-led initiative aims to strengthen the 340B program by increasing transpar Read More . . .

Franchise Fee Assessment Letters Mailed to Hospitals

10/31/2018

ODM has mailed the Hospital Franchise Fee assessment letters to providers. A sample letter can be found here. If you do not receive your letter by mid-October, please contact ODM as soon as possible. The first franchise fee assessment will be due to ODM on Oct. 29. The subsequent UPL payment will be paid to providers on Nov. 12. P Read More . . .

Provider Update: Early Issues with New Medicare Cards

09/28/2018

Ohioans covered by Medicare should be receiving their new Medicare cards, however the Centers for Medicare & Medicaid Services report some new cards have been accidentally thrown away because they were sent in non-descript envelopes.PLEASE INFORM YOUR MEDICARE PATIENTS when speaking with them regarding appointments and schedulin Read More . . .

Medicare Open Enrollment Begins Oct. 15

09/28/2018

As the 2019 Medicare open enrollment period approaches, Jillian Froment, director of the Ohio Department of Insurance, is encouraging Medicare beneficiaries to review their drug and health insurance coverage options and select a plan that fits their needs and budget.   The Ohio Senior Health Insurance Information Program, a d Read More . . .

OHA Comments on CY 2019 Physician Fee Schedule Proposed Rule

09/28/2018

The Ohio Hospital Association on Sept. 10 submitted comments on the Centers for Medicare & Medicaid Services' Physician Fee Schedule proposed rule for calendar year 2019. OHA offered recommendations with respect to evaluation and management visit code changes, Part B drug reimbursement, expanding access to virtual care and t Read More . . .

Ohio Medicaid Provides Hospitals with Claim Correction Updates

09/28/2018

The Ohio Department of Medicaid's Bureau of Health Plan Policy on Sept. 21 updated hospitals during the Large Provider Group meeting on the following topics:  Medicaid fee-for-service has been discounting or packaging the second day of observation in some cases, and ODM states it has always been its intent to reimburse for Read More . . .

Webinar Available on 2016 DSH Audit

09/28/2018

Myers & Stauffer has pre-recorded a webinar on the 2016 DSH audit process. The webinar can be found here. The slides can be found here. There will be a two-week period to submit question not answered in or arising from the webinar. Submit questions to Daniel Vielhaber by Oct. 8. Myers & Stauffer has informed OHA that its Pr Read More . . .

CareSource Provides Operational Updates to OHA, LPG

09/28/2018

CareSource leadership on Sept. 19 and Sept. 24 provided updates to OHA’s Admitting, Billing & Collection Committee as well as Ohio’s Large Provider Group on a comprehensive list of outstanding issues OHA has been monitoring and pushing for resolution on for more than a year on behalf of member hospitals. The core is Read More . . .

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