Finance News

The latest news and updates on federal and state hospital and health system reimbursement policies and procedures.

View OHA's monthly finance alert wrap up - By the Numbers

Archive Copy: March 13 OHA, KEPRO Webinar on Ohio Medicaid’s Program Integrity Contractor


OHA and KEPRO hosted a webinar March13, "KEPRO: Ohio Medicaid’s Program Integrity Audit Update." An archive copy of the webinar is available here. A copy of the PowerPoint presentation for the session is available here.  Read More . . .

ODM Guidelines for Hysterectomy, Sterilization and Abortion Certification Forms Published


The Ohio Department of Medicaid on March 14 published its guidance to complete: DM 03197, "Abortion Certifiction Form"ODM 03199, “Acknowledgement of Hysterectomy Information”here for the guidance information. U.S. Department of Health and Human Services Form HHS-687, “Consent for Sterilization&r Read More . . .

ODM Announces MITS Fixes Delayed Until Further Notice


The Ohio Department of Medicaid notified OHA that the implementation date is delayed until further notice for the following MITS fixes: Incorrect duplicate denials within and across dates of service for pharmaceutical details on outpatient invoice claims.Outpatient crossover claims are not correctly calculating reimbursement when M Read More . . .

Federal Court Voids CMS Rule on Medicaid DSH Audits


The U.S. District Court for the District of Columbia on March 6 voided the CMS rule regarding how third-party payments, such as private insurance or Medicare, are treated for purposes of calculating the hospital-specific limitation on Medicaid disproportionate share hospital, or DSH, payments.The DSH Rule, issued in April 2017, Read More . . .

Ohio SIM: Episode Based Payment Updates


To date, the Ohio Department of Medicaid, in collaboration with the Governor’s Office of Health Transformation, has designed and launched reporting on 43 episodes of care. Nine of these episodes are currently linked to financial incentives.   In line with ODM’s thresholding methodology, quality metric thresholds fo Read More . . .

Reminder: Important March CMS Deadlines


Physicians participating in the Merit-based Incentive Payment Program, or MIPS, must submit 2017 data for groups reporting through the CMS Web Interface by 8 p.m. ET March 16, with all other MIPS 2017 data reporting due on March 31. This includes those reporting via due date for providers to submit a non-binding Read More . . .

Registration Open for April CGS Medicare Road Shows


CGS Medicare will host a Medicare Road Show on April 3 in Cleveland, April 4 in Columbus and April 5 in Cincinnati. Plan to attend at the city nearest you and register here. This day-long event will include presentations on topics of interest to both Medicare Part A and Part B providers and their staff members. Speakers i Read More . . .

CMS to Expand Patient Access to E-health Records


The Centers for Medicare & Medicaid Services announced MyHealthEData this week, a federal initiative to expand patients electronic access to their medical data. The White House Office of American Innovation will lead the initiative, which will also include the U.S. Department of Health and Human Services' Office of the Read More . . .

Ohio Medicaid Restructuring Provider Payment Cycles


The Ohio Department of Medicaid announced last week that there will be a permanent one-week delay in weekly payment cycles beginning April 5. The change will not impact the timing of ODM's HCAP or UPL payments. However, it will affect those UPL payments that ODM makes after the upload for primary UPL payment, as they generally a Read More . . .

CMS Begins Low Volume Appeals Settlement Process


The Centers for Medicare & Medicaid Services on Feb. 5 started accepting expressions of interest for the Low Volume Appeals settlement process. The LVA settlement option is for providers, physicians, and suppliers (appellants) with: Fewer than 500 appeals pending at the Office of Medicare Hearing and Appeals and the Medica Read More . . .

Reminder: Review BWC 2018 OPPS Final Rule Details


Please take time to review the Ohio Bureau of Workers’ Compensation proposed rules released on Feb. 13 to update  2018 Hospital Outpatient Reimbursement located here. A public hearing for the rule is scheduled for March 22.   BWC historically models rate setting and billing rules in coordination with Medicare&rsquo Read More . . .

Hospital Associations Urge Court to Stop 340B Payment Cut


Thirty-five state and regional hospital associations on Feb. 22 urged the U.S. Court of Appeals for the District of Columbia Circuit to reverse a district court decision and grant a preliminary injunction to stop a nearly 30 percent Medicare payment reduction for many hospitals in the 340B Drug Pricing Program while the American Hos Read More . . .

Federal Budget Tools, Presentations Available


Following the flurry of budget activity in Washington, D.C., the American Hospital Association has released tools to help explain the many hospital-related elements in the various budget bills to staff and hospital boards. This AHA Legislative Advisory reviews the key provisions of the bill and this PowerPoint slide deck is availabl Read More . . .

Medicare Hospital Attestation Deadline Extended to March 16


The Medicare eligible hospital and critical access hospital attestation deadline has been changed from Feb. 28 to 11:59 p.m. PT on  March 16. This extension is being granted to provide hospitals additional time to submit attestation data and eCQM data. Eligible hospitals and CAHs attesting to CMS for the EHR Incentive Pr Read More . . .

Anthem Rescinds Modifier 25 Policy


In a letter to the American Medical Association on Feb. 23, Anthem rescinded it's reimbursement policy related to the physician use of payment modifer 25, set to take effect on March 1 across the company's commerical health insurance businesses. Anthem made the decision not to proceed with rolling out the policy even though Read More . . .

EAPG, Budget Monitoring Project Update


The Ohio Hospital Association has been working closely over the past few months with interested hospitals to sign agreements to participate in the EAPG and Ohio Medicaid budget monitoring project. Approximately 100 hospitals have committed to move forward with the monitoring, and several more contracts are in process. If your hospi Read More . . .

Ohio Medicaid’s Managed Care Plans Release Consolidated Plan Resource Guide


Ohio’s Medicaid Managed Care Plans released a consolidated resource guide this month to assist providers in reaching out to the plans to secure information such as CPC engagement, care management solutions, benefits and programs, case management, chronic disease management, transportation assistance, 24-hour nurse line informa Read More . . .

Anthem’s New ER Policy: How Hospitals Can Help


Anthem Blue Cross Blue Shield on Jan. 1 implemented a new policy in Ohio in which it will deny coverage if a patient receives care in an emergency department and Anthem determines the patient’s need for care was not emergent based on Anthem’s retrospective review of the diagnosis.Call to Action: Collect Examples of Patie Read More . . .

Reminder: ODM's Integrity Auditor Reinstates Technical Denials


The Ohio Department of Medicaid last month gave its auditor, KEPRO, the approval to reinstate technical denials when records are not submitted within 30 days of KEPRO's request. ODM selected KEPRO last summer to be the department’s utilization review vendor (replacing Permedion). OHA released this Read More . . .

SAVE the DATES: CGS J15 Medicare Contractor Coming to Ohio


Want to talk to your Medicare Administrative Contractor? Then, mark your calendars and plan to join the J15 Provider Outreach and Education team for the upcoming Medicare Roadshow events in Ohio. CGS will be meeting in Cleveland Columbus and Cincinnati on April 3, 4 and 5.  The day-long events will include education Read More . . .

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