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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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No Medicaid Rate Cut for Ohio Hospitals in SFY 2018

11/30/2017

The Ohio Department of Medicaid confirmed Nov. 13 that the department will be withdrawing the 5 percent rate cut rule it submitted on Oct. 17 and will not cut hospital rates for the remainder of state fiscal year 2018.   “OHA appreciates the willingness of the Kasich Administration and Ohio’s General Assembly to e Read More . . .

Transparency Lawsuit Hearing Delayed, New Legislation Introduced

11/30/2017

The Williams County Court of Common Pleas announced the preliminary injunction hearing regarding OHA’s challenge to the price transparency law is delayed from Dec. 20-21 to March 15-16, 2018. The judge indicated that he needs more time to process briefs related to State Rep. Jim Butler’s motion to intervene in the lawsui Read More . . .

OHA Finance Committee Studies Franchise Fee Reforms

11/30/2017

For the better part of this year, the OHA Finance Committee has examined challenges presented by the existing franchise fee – growing fees resulting from hospital expense growth, shrinking traditional Medicaid caseloads that lead to shrinking Upper Payment Limit payments and new federal policies preventing the expans Read More . . .

OHA's EAPG & Biennium Budget Monitoring Project Update

11/30/2017

OHA and corporate partner BKD continue to work with member hospitals in securing agreements for the EAPG & Biennium Budget Monitoring Project for state fiscal years 2018 and 2019.   If you would like to participate in the Base Package, please notify Shawn Stack if you haven’t already done so, and he will i Read More . . .

2018 Final Medicare Outpatient Prospective Payment System Rule Analyzed

11/30/2017

Earlier this month, the Centers for Medicare & Medicaid Services issued the 2018 outpatient prospective payment system/ambulatory surgical center final rule. In addition to standard updates, the rule implements significant cuts to non-exempted services furnished in off-campus provider-based departments and to nonpass-throug Read More . . .

House Passes CHIP Extension, Medicaid DSH Relief

11/30/2017

The U.S. House voted 242-174 on Nov. 3 to pass a five-year funding extension for the Children's Health Insurance Program, which expired in September. But partisan disputes over funding offsets leave it unclear when legislation to reauthorize the popular program will actually be signed into law. The Championi Read More . . .

CMS Issues MACRA, Physician Payment Rules

11/30/2017

The Centers for Medicare & Medicaid Services on Thursday issued its final rule for the physician fee schedule for calendar year 2018. CMS estimates a 0.41 percent increase in physician payment rates for 2018 compared to 2017. In addition, CMS makes changes to its policies implementing the site-neutral provisions that requir Read More . . .

CMS Announces Medicare Premiums, Deductibles for CY 2018

11/30/2017

Adding to the list of calendar year 2018 Medicare program updates announced this month, the Centers for Medicare & Medicaid Services announced its Medicare Part A deductible for inpatient hospital services will increase by $24 in calendar year 2018, to $1,340. The Part A daily coinsurance amounts will be $335 for days 61-90 of h Read More . . .

ODM Updates 340B ‘SE’ Modifier Implementation Date for Hospital 340B Entities

11/30/2017

The Ohio Department of Medicaid’s policy team announced in a notification to OHA on Nov. 7 that all 340B entities that bill on a hospital outpatient UB04 will be required to bill an SE modifier on all 340B drug lines provided in an outpatient setting beginning Jan. 1, 2018, a delay from the requirement that was stated to Read More . . .

ODM Makes Adjustment on Nov. 9 Remittance Advice

11/30/2017

The Ohio Department of Medicaid processed a mass adjustment that appeared on the remittance advices for Nov. 9. The purpose of the mass adjustment was to correct an issue where MITS was not appropriately deciding when to pay using their standard DRG payment logic or to use the per diem based logic. The claims selected were claims wi Read More . . .

Just the Facts - November 2017

11/30/2017

Medicare’s Quality Improvement Organization, KEPRO, now allows hospital providers to schedule a Short Stay review education session when hospitals receive an initial determination letter with a major concern. Access the online tool to schedule a session here.   Reminder that adoption of Medicare’s revised forms Read More . . .

OHA Meeting with State Leaders on 2 Critical Medicaid Payment Issues

10/31/2017

The Ohio Hospital Association, along with other provider associations, met Oct. 5 with the directors of the Governor's Office of Health Transformation and the Ohio Department of Medicaid as well as a representative from the Governor's office to hear updates on plans to move forward on two issues of key importance to the hosp Read More . . .

ODM Rate Cut Rule Filed

10/31/2017

As expected, the Ohio Department of Medicaid filed the rule implementing a 5 percent hospital rate cut. See the rule, the public notice, and other documents here. Note that the public hearing and deadline for written comments is Nov. 17. OHA plans to oppose this rule. OHA will be in touch with more information soon on outreach plan Read More . . .

OHA Releases Patient Education Letter Template in Response to Anthem’s Radiologic Policies

10/31/2017

The Ohio Hospital Association on Oct. 12 released a patient communication template hospitals can use to communicate with patients impacted by Anthem BCBS’s new outpatient radiologic policy implemented in Ohio on Sept. 1.   The template  assists hospitals in explaining the benefits patients may want to consider Read More . . .

OHA Releases Preliminary Hospital-Specific 2018 UPL Payment Data

10/31/2017

OHA on Oct. 11 posted the projected 2018 Upper Payment Limit amounts due to hospitals here. UPLs were calculated in this preliminary run to be $488.3 million statewide, which is $50 million (or 9.3 percent) lower than SFY 2017 payments. Most hospitals will see a decline due to continued erosion of traditional Medicaid fee-for-servi Read More . . .

CMS Releases Correction Notice for Final FY 2018 Medicare IPPS and LTCH Update

10/31/2017

The Centers for Medicare and Medicaid Services have issued a correction notice to the FY 2018 final inpatient prospective payment system and Long-term Care Hospital rule that was released on Aug. 14. The notice amends the IPPS operating and capital related costs, with impacts to long-term care hospitals as well and is effective retr Read More . . .

CMS Releases Correction Notice for Final FY 2018 Medicare SNF PPS Rates, Wage Index Values

10/31/2017

The Centers for Medicare & Medicaid Services issued a correction notice to the FY 2018 skilled nursing facility prospective payment system rates and wage index values. The notice corrects the FY 2018 SNF PPS wage index budget neutrality factor and per diem rates based on correlation to the error in the wage data that was us Read More . . .

CMS Issues Instructions for Worksheet S-10

10/31/2017

The Centers for Medicare & Medicaid Services issued new and revised instructions for charity care and bad debt data reported by hospitals on worksheet S-10 of the Medicare Cost Report. This data is now used for the distribution of Medicare Disproportionate Share Hospital, or DSH, funding. See this Medicare Learning Network Read More . . .

Window Extended for Hospitals to Amend CMS Worksheet S-10 Reporting

10/31/2017

The Centers for Medicare & Medicaid Services has extended the window from Oct. 31 to Jan. 2, 2018 for hospitals to amend uncompensated care, bad debt and other Worksheet S-10 reporting on their fiscal year 2014 and 2015 Medicare cost reports.   Proper reporting of S-10 data is critical, as it is now us Read More . . .

CareSource Shows Good-Faith in Resolving Claims Issues

10/31/2017

Ohio Hospital Association representatives met with CareSource’s Ohio president, vice president of Ohio Market Operations and Ohio Government Affairs director Oct. 3 in Columbus to talk through CareSource’s plan to address communication and claims issues that have been impacting payments and taxing administrative resource Read More . . .

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