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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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Don’t Miss OHA’s Annual Medicare, Medicaid Update Seminar

08/31/2018

Hospital executives, in-house counsel, auditors, controllers and reimbursement and patient financial services team members are invited to attend the “Medicare and Medicaid in 2019” seminar Sept. 20 in Columbus. Please note this seminar was formerly known as the Larry and Larry Show.   Each fall, OHA presents a sem Read More . . .

CMS Releases Final FY 2019 Hospital IPPS Rule

08/31/2018

The Centers for Medicare & Medicaid Services on Aug. 2 released its Hospital Inpatient Prospective Payment System final rule for fiscal year 2019. The rule will increase rates by 1.85 percent in FY 2019 compared to FY 2018, after accounting for inflation and other adjustments required by law. The final rule includes an ini Read More . . .

OHA Publishes Final FFY 2019 Medicare IPF Payment Rule Brief

08/31/2018

The final calendar year 2019 payment rule for the Medicare Inpatient Psychiatric Facility Payment System, or IPF, was released Aug. 6. The final rule reflects the annual update to the Medicare fee-for-service IPF payment rates and policies. The final rule includes:    An overall rate increase amount +1.5 percentMul Read More . . .

OHA Publishes Proposed CY 2019 Medicare OPPS Payment Rule Brief

08/31/2018

The proposed calendar year 2019 payment rule for the Medicare Outpatient Prospective Payment System was released on July 25. The proposed rule includes annual updates to the Medicare fee-for-service outpatient payment rates as well as regulations that implement new policies. The proposed rule includes policies that will:   Ch Read More . . .

OHA Publishes Final FFY 2019 Medicare IRF Payment Rule Brief

08/31/2018

The final federal fiscal year 2019 payment rule for the Medicare Inpatient Rehabilitation Facility Payment System, or IRF, was released Aug. 6. The final rule reflects the annual update to the Medicare fee-for-service IRF payment rates and policies. The final rule confirms:    The IRF Standard Payment Conversion Fa Read More . . .

CMS Releases Final FY 2019 Hospice Rule

08/31/2018

The Centers for Medicare & Medicaid Services released its Hospice Final Rule for FY 2019 on Aug. 2 that will take effect on Oct. 1. The rule will increase both aggregate hospice payments and the statutory annual cap by 1.8 percent ($340 million) from FY 2018 levels, based on a hospital market-basket update of 2.9 percent, minus Read More . . .

CMS Releases Final FY 2019 LTCH PPS Rule

08/31/2018

The Centers for Medicare & Medicaid Services released its Long-Term Care Hospital Prospective Payment System Final Rule for fiscal year 2019 on Aug. 2 that will take effect on Oct. 1. The rule will increase rates by a net of 1.0 percent ($35 million), while payment rates for site-neutral cases will increase by a net of 0.4 perc Read More . . .

OHA Transparency Update: Case on Hold Pending Procedural Ruling

08/31/2018

The Ohio Hospital Association filed a lawsuit in December 2016 to prevent an unworkable state law imposing new hospital price transparency requirements from becoming effective in January 2017. To date, OHA has succeeded in preventing the law from going into effect.  The initial court order issued on Dec. 22, 2016 preventing th Read More . . .

Myers & Stauffer Updates Patient Log Template

08/31/2018

Myers & Stauffer updated the Patient Log Template for the 2016 federal DSH audit in the following ways:   Log 10 tab: clarification has been added that charges on this log should correspond with charges reported on Schedule J6 of the Medicaid cost report.New tabs: “Rev Code Crosswalk Instructions” and &ld Read More . . .

Ohio Medicaid Updates Outpatient Hospital Behavioral Health Diagnosis Code List Online

08/31/2018

The Ohio Department of Medicaid’s Policy Team rolled out an updated diagnosis code list. The new list located here, with a revision date of Aug. 10, 2018, includes a number of new ICD-10CM codes the department updated to be acceptable when providing and billing outpatient hospital behavioral health services. Please contact Sh Read More . . .

ODM Offers Webinar Series on Episodes, Register Today

08/31/2018

The Ohio Department of Medicaid is hosting a series of webinars on episodes. These webinars will cover a variety of topics that may be useful for principal accountable providers:   Wednesday, Sept. 26, 10-11 a.m. – Update on Episode reportsTuesday, Oct. 23, 10-11 a.m. – Wave 3 Episodes tied to paymentWed Read More . . .

ODM Releases Updated APR-DRG Relative Weights

08/31/2018

The Ohio Department of Medicaid’s Hospital Policy Department on Aug. 16 released Ohio Medicaid’s inpatient relative weights for hospitals. The APR-DRG relative weight table is effective for hospital inpatient Medicaid discharges on or after Sept. 1, 2018 and can be accessed here. Please contact Shawn Stack with question Read More . . .

CareSource Continues Focus on Operational Updates Shared with OHA

08/31/2018

CareSource leadership on Aug. 9 provided further updates on a comprehensive list of outstanding issues OHA has been working on with Ohio’s largest Medicaid managed care payer. The core issues include claim processing breakdowns, covered service discrepancies, inappropriate denials, authorization issues surrounding medical Read More . . .

OHA Reiterates Ohio Medicaid’s Directive to Plans Managing Transition of Care Coverage

08/31/2018

Member hospitals report that they struggle to secure payment for services rendered to Medicaid recipients who present with Presumptive Fee-for-Service Medicaid coverage for medical services and then later are converted to managed care coverage for that same month, backdating the managed care effective date to the first date of the m Read More . . .

Just the Facts - August 2018

08/31/2018

Assessment and distributions for 2018 HCAP are expected to be delayed until mid-November. The delay is the result of the rule change for rural designation - a hospital will only be considered rural if it exists in a rural county. ODM does not have new dates for assessments and distributions but stay tuned to Finance News for updates Read More . . .

Hold the Dates - August 2018

08/31/2018

Save Tuesday, Sept. 18 from 10 a.m. to noon for OHA’s Health Economics & Policy Webinar on “Ohio Bureau of Workers’ Compensation 2019 IPPS & Best Practices in BWC Billing and Coding. Member hospitals can register here for the free webinar.  The Central Ohio Chapter of HFMA is offering OHA Medica Read More . . .

CMS Proposes Updates to CY 2019 Hospital Outpatient Prospective Payment System

07/31/2018

The Centers for Medicare & Medicaid Services on July 25 issued a proposal to update the calendar year 2019 hospital outpatient prospective payment system rates by 1.25 over CY 2018 rates. The agency’s release also includes site-neutral payment policy changes that would reduce the payment rate for hospital outpatient clinic Read More . . .

Proposed CY 2019 CMS Updates Released for Physician Fee Schedule, Revisions to Part B

07/31/2018

CMS on July 12 issued a proposal to update physician fee schedule rates by 0.25 percent in calendar year 2019. The impact of the proposed update and the budget-neutrality adjustment required by law yields a proposed 2019 PFS conversion factor of $36.05, an increase of $.06 over last year. The rule also proposes to reduce payment for Read More . . .

CMS Proposes CY 2019 Home Health Update and CY 2020 Redesign

07/31/2018

CMS on July 2 released the home health prospective payment system proposed rule for calendar year 2019, which also proposes a major redesign for CY 2020. CMS will accept comments on the proposed rule through Aug. 31. Please contact Shawn Stack with questions. Read More . . .

Medicare Debuts myCGS Dashboard for Providers to Track Medical Review Requests

07/31/2018

Ohio’s Medicare Administrative Contractor, CGS, has launched the myCGS MR Dashboard for providers to quickly identify medical review additional document requests, or ADRs, sent to the hospital. Medical Review, or MR, department staff occasionally needs additional documentation from providers in order to process claims.  Read More . . .

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