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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
 

OHA Reminds Hospitals of Medicaid Reimbursement for Private Rooms

07/18/2018

Ohio Medicaid allows reimbursement for private rooms under specific conditions, yet OHA has learned many providers are not seeking reimbursement. To avoid lost revenue, services must be billed under the following conditions: When a private room is medically necessaryWhen a hospital has no semi-private roomWhen the patient chooses a Read More . . .

CMS Updates Deadline for MIPS Review Requests

07/18/2018

The Centers for Medicare & Medicaid services recently announced the deadline for submitting a MIPS Targeted Review Request is now Oct. 1.If providers participated in the Merit-based Incentive Payment System, or MIPS, in 2017, their MIPS final score and performance feedback is now available for review on the Quality Payment Read More . . .

State Promotes Mental Health Parity as Behavioral Services Shift to Managed Care

07/13/2018

The Ohio departments of Medicaid and of Mental Health and Addiction Services on July 1 released a report examining compliance by managed care plans in providing parity in patients' access to those services. With the July 1 carve-in of behavioral health services in Medicaid into managed care, the state says it is now compliant wi Read More . . .

ODM Updates Hospital Billing Guidelines

07/11/2018

The Ohio Hospital Association’s Health Economics & Policy team recommends member hospitals review the New Medicaid Hospital Guidelines for claims with dates of discharge and dates of service on or after July 1, 2018.   The most recent updates include clarification on the following items: Instance in which Medicaid Read More . . .

CMS Proposes CY 2019 Home Health Update and CY 2020 Redesign

07/09/2018

The Centers for Medicare & Medicaid Services 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.   Read More . . .

CMS Delays Due Dates for New Bundled Payment Model

07/09/2018

The Centers for Medicare & Medicaid Services has extended the deadline for submitting signed participation agreements and selecting clinical episodes for the Bundled Payments for Care Improvement Advanced model by one week to Aug. 8, and the due date for program deliverables to Sept. 14.    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 . . .

OHA Comments on FY 2019 IPPS Proposed Rule

06/26/2018

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 Read More . . .

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

06/25/2018

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 . . .

EAPG, Budget Monitoring Project Update

06/22/2018

The Ohio Hospital Association continues to work with 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 BKD Read More . . .

Update: SFY 2018 Hospital Cost Report Posted

06/22/2018

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 . . .

Reminder: Medicaid Specifies Billing for LARC Devices

06/18/2018

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 . . .

Providers: Prepare for Ohioans with New Medicare Cards

06/14/2018

Ohioans covered by Medicare should begin receiving their new Medicare cards beginning the end of June. 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 Be Read More . . .

ODH Requires Community Benefit Documents from Hospitals July 1

06/12/2018

Tax-exempt hospital should have received a letter from the Ohio Department of Health dated May 29 restating requirements to submit community benefit documents by July 1. This state requirement was enacted in July 2016 and requires that all tax-exempt hospitals submit community health needs assessment and improvement plans to ODH. It Read More . . .

New Medicare Cost Reporting E-Filing Effective June 12

06/11/2018

The new Medicare Cost Reporting e-filing system went into effect June 12. The April 30 MLN Matters Article MM106011 explains the new e-filing system is intended for cost report staff submitting annual Medicare Cost Reports, or MCRs, to Medicare Administrative Contractors, or MACs, for services provided to Medicare ben Read More . . .

OHA Publishes Ohio Medicaid Billing, Reimbursement FAQ

06/08/2018

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 . . .

BWC Clarifies Behavioral Health Services in New Rule

06/08/2018

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, his Read More . . .

Archive Copy: June 7 OHA HCAP Update Webinar

06/07/2018

OHA’s Health Economics & Policy team on June 7 hosted a webinar, " OHA HCAP 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's Hospital Policy Team Issues Updates

06/06/2018

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 P Read More . . .

ODM Announces Downtime to OBWP County Portal, Deemed Newborn/PE Portal

06/04/2018

Ohio Department of Medicaid on June 1 announced providers will experience downtimes to the OBWP and 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 Read More . . .

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