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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 Comments on FY 2019 IPPS Proposed Rule

06/29/2018

The Ohio Hospital Association on June 25 submitted comments on the Centers for Medicare & Medicaid Services' inpatient prospective payment system proposed rule for fiscal year 2019, offering recommendations with respect to Medicare Disproportionate Share Hospital, or DSH, payment, CAR T-cell therapy, the wage index, hospital Read More . . .

Register Now for the OHA, FHA Annual Medicare 101 Training

06/29/2018

The Ohio Hospital Association and Florida Hospital Association are teaming up again to present a comprehensive review of Medicare provider reimbursement systems and cost reporting July 26 in Columbus. The popular annual “Medicare 101” seminar is designed for trustees and hospital employees who are new to health care faci Read More . . .

Providers: Prepare for Ohioans with New Medicare Cards

06/29/2018

Ohioans covered by Medicare should begin receiving their new Medicare cards in July. New Medicare cards are being sent out nationwide through April 2019 to replace existing Health Insurance Claim Numbers, or HICNs. There is a 21-month transition period where providers will be able to use either the new Medicare Beneficiary Identifi Read More . . .

ICD-10 Rule for Non-Opioid Controlled Substances Effective July 1

06/29/2018

This has been a busy 12 months for new rules around opioid prescribing. The 5-day (minors) and 7-day (adults) rules for acute pain prescriptions were effective Aug. 31, 2017, and prescribers started adding the ICD-10 diagnosis code to all opioid prescriptions in December 2017. The second phase of the ICD-10 requirement, listing the Read More . . .

Ohio Medicaid Postpones Hospital Rate Cut

06/29/2018

The Ohio Department of Medicaid on May 31 confirmed to OHA that the department will be further postponing its proposed 5 percent rate cut and will not cut hospital rates for the remainder of calendar year 2018. The department also announced it would reduce the proposed inpatient recalibration and eliminate the outpatient recalibrati Read More . . .

Update: SFY 2018 Hospital Cost Report Posted

06/29/2018

The Ohio Department of Medicaid has posted the SFY 2018 Hospital Cost Report and instructions on its website. A link to download the files can be found here. The completed cost report must be postmarked on or before June 30 for hospitals filing with a cost reporting period ending between July 1, 2017 and Dec. 31, 2017. For hospital Read More . . .

Plan Now for 3M Hospital Group Update on June 27

06/29/2018

The Ohio Hospital Association continues to work with OHA Corporate Partner BKD and interested hospitals to monitor and engage with the Ohio Department of Medicaid and managed care payers on the processing of outpatient claims under 3M’s EAPG algorithms.   While the front-end process and set-up has been rigorous, OHA and Read More . . .

ODM's Hospital Policy Team Issues Updates

06/29/2018

Ohio Department of Medicaid's Bureau of Health Plan policy on June 1 provided updates on EAPG issues that for the past several months have been impacting providers that bill under the new outpatient reimbursement grouper for Ohio Medicaid’s patient population. Additional topics addressed in ODM’s update at the Large Read More . . .

OHA Publishes Ohio Medicaid Billing, Reimbursement FAQ

06/29/2018

OHA’s Health Economics & Policy Team has been working closely with ODM and corporate partner BKD, LLC over the past several months to review Medicaid claims submitted to Ohio’s Medicaid Payers since the Ohio Medicaid inpatient and outpatient rebase and EAPG implementation occurred in July and August of 2017. As a res Read More . . .

Reminder: Medicaid Specifies Billing for LARC Devices

06/29/2018

When a long acting reversible contraceptive, or LARC device, that is covered by Ohio Medicaid is provided to a Medicaid recipient in an inpatient hospital setting postpartum and prior to the patient’s discharge, the hospital may submit an outpatient claim for the LARC. The claim for the LARC is separate from any claim submitte Read More . . .

ODM Announces Downtime to Presumptive, Deemed Eligibility Portal

06/29/2018

ODM on June 1 announced providers will experience downtimes to the Presumptive and Deemed Eligibility Portal due to system upgrades to incorporate cash and food assistance status into beneficiaries' records. Providers will experience downtimes during the following upgrade periods: June 29, 6 p.m. – July 2,  6 a.m.Ju Read More . . .

BWC Clarifies Behavioral Health Services in New Rule

06/29/2018

Effective July 1, a proposed new rule, OAC 4123-6-33, would govern the Ohio Bureau of Workers' Compensation reimbursement for health and behavior assessment and intervention, or HBAI, services. HBAI service codes have been included in the BWC Professional Provider & Medical Services Fee Schedule since 2008. However, hi Read More . . .

Just the Facts - June 2018

06/29/2018

The June edition of the Ohio Bureau of Workers’ Compensation Provider e-News is available here. Read More . . .

Hold the Dates - June 2018

06/29/2018

“Medicare 101,” a one-day Medicare policy, PPS (what is this acronym) seminar produced in cooperation with the Florida Hospital Association. This popular program is scheduled on June 22. Register online here.   Save Tuesday, July 10 from 10 a.m. to noon for OHA’s Health Economics & Policy Webinar on Oh Read More . . .

Federal Disproportionate Share Hospital Audit Released May 14

05/31/2018

The results for the 2015 Federal Disproportionate Share Hospital Audit conducted by Myers & Stauffer for the Ohio Department of Medicaid began being released May 14. Hospitals that Myers & Stauffer determined to be in a recoupment status will be released first. Hospitals in recoupment status have 10 days to contact Myers &a Read More . . .

Verma Draws the Line on Medicaid Limits

05/31/2018

CMS Administrator Seema Verma on May 7 offered hospital executives good and bad news on Medicaid coverage limits and accountable care organizations' risk contracts during her presentation to the American Hospital Association annual meeting. CMS will reject Kansas' request to impose lifetime limits on Medicaid coverage, Read More . . .

OHA Works with ODM to Improve Communications Through Medicaid Managed Care Contracts

05/31/2018

The Ohio Hospital Association, through the Admitting, Billing & Collection Committee, last month was able to get new language added to future Ohio Department of Medicaid Managed Care Plan Provider Agreements. The new language: “The MCP is required to give a 30-calendar day advanced notice to providers of any new edits Read More . . .

CareSource Provides Operational Updates to OHA

05/31/2018

CareSource leadership on May 14 provided updates on a comprehensive list of outstanding issues OHA has been working for more than a year to resolve on behalf of member hospitals with Ohio’s largest Medicaid managed care payer. The core issues include claim processing breakdowns, covered service discrepancies, inappropriate den Read More . . .

Director Sears Provides Behavioral Health Redesign Update

05/31/2018

Barbara Sears, director, Ohio Department of Medicaid, on May 7 discussed the status of Behavioral Health Redesign with the Joint Medicaid Oversight Committee. You can view her presentation here. Read More . . .

ODM Reports Issues with Medicare/Medicaid Secondary Claims Processing

05/31/2018

The Ohio Department of Medicaid reports that some Medicaid secondary claims experienced processing issue during the month of April. The processing issue providers may see is that the Medicare paid amount is zero and the payment went to the deductible instead of paying Med Max. ODM advised that providers may adjust their claims, howe Read More . . .

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