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

Save the Date for OHA, FHA at Annual Medicare 101 Training


The Ohio Hospital Association and Florida Hospital Association are teaming up 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 facility f Read More . . .

CMS Summer Webinar Series Starts June 6


Join the Centers for Medicare & Medicaid Services Chicago Regional Office webinar series beginning June 6. This new series includes webinars on the Quality Payment Program, new Medicare card project and Medicare provider enrollment process. Each webinar includes a question and answer session.Quality Payment Progra Read More . . .

Anthem Announces New Commercial Facility Reimbursement Policy


Anthem Blue Cross Blue Shield announced its new policy for Ohio, Indiana, Kentucky and Missouri that will become effective Aug. 1. The policy details the health plan’s guidelines for claims requiring additional documentation and the facility’s compliance for the provision of requested documentation. In addition to the r Read More . . .

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


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 . . .

Medicare A & B Providers Join WPS GHA & CGS in Louisville, KY


Join WPS Government Health Administrators and CGS Administrators, LLC in Louisville, KY on June 12 for a collaborative event covering the following topics of interest for all A/B Providers: Billing during a leave of absence (LOA/interrupted stay)What “hospital bundling” includesHow to determine the proper patient status Read More . . .

Archive Copy: April 10 OHA Webinar on ODM Retrospective Claims Review


OHA’s Health Economics & Policy team on May 8 hosted a webinar, " KEPRO: ODM Retrospective Claims Review.” An archive copy of the webinar is available here. A copy of the PowerPoint presentation for the session is available here. Read More . . .

CareSource Provides Operational Updates to OHA


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 . . .

OHA Releases Brief on CMS Proposed FY 2019 Inpatient Psychiatric Facility Prospective Payment System Rule


CMS on May 8 issued its Proposed Fiscal Year 2019 Medicare Inpatient Psychiatric Facility Prospective Payment System, or IPF, Rule update. The rule proposes to increase inpatient IPF payment rates by a combined  1.4 percent.OHA’s Payment Rule Brief can be found at the link here.  Please reach out to Shawn Stack Read More . . .

OHA Releases Brief on CMS Proposed FY 2019 IRF Prospective Payment System Rule


CMS on May 8 published its Proposed Fiscal Year 2019 Medicare Inpatient Rehabilitation Facility Prospective Payment System, or IRF, Rule Update. The rule proposes to increase the IRF Standard Conversion Factor 1.15 percent.OHA’s Payment Rule Brief can be found at the link here. Please reach out to Shawn Stack with any questio Read More . . .

Study: More Medicare Drug Plan Enrollees Hitting Out-of-Pocket Limit


The number of Medicare Part D beneficiaries who reach the catastrophic coverage phase of the prescription drug benefit rose by more than 50 percent between 2013 and 2016, according to an analysis released May 10 by Avalere. The study looked at the 72 percent of Part D beneficiaries who do not receive low-income subsidies and fo Read More . . .

Federal Disproportionate Share Hospital Audit Set for May 14 Release


The results for the 2015 Federal Disproportionate Share Hospital Audit conducted by Myers & Stauffer for the Ohio Department of Medicaid will be released beginning 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 My Read More . . .

Sears Provides Behavioral Health Redesign Update


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 . . .

Verma Draws the Line on Medicaid Limits


CMS Administrator Seema Verma offered hospital executives on May 7 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 . . .

Medicare’s Launches MBI Look-Up Tool


New Medicare cards are being sent to beneficiaries through April 2019, and a substantial transition period will be in place from through Dec. 31, 2019 for providers to use either the Health Insurance Claim Number, or HICN, or the new Medicare Beneficiary Identifier for all Medicare transactions. Providers can use the myCGS MBI Read More . . .

Reminder: Comments due to CMS by June 25


The Centers for Medicare & Medicaid Services released its FFY 2019 Inpatient Prospective Payment System (IPPS) proposed payment rule. While OHA is working with our consultant on an in-depth analysis, a few key points and issues have already emerged in our review. The proposed rule reflects the annual updates to the Medicar Read More . . .

Administration Submits Medicaid Work Requirement Waiver


The Ohio Department of Medicaid on April 30 submitted a request for federal approval to levy work requirements on certain enrollees, a program they hope to have up and running by July 1. Lawmakers required the program in the biennial budget (HB 49), and the proposal roughly aligns with existing work and community engagement require Read More . . .

KEPRO Launches Quarterly KEPRO Connect Ohio Newsletter!


The Ohio Department of Medicaid’s program integrity quality contractor, KEPRO, launched its first quarterly Ohio newsletter this week. The first KEPRO Connect Ohio newsletter focuses on substance use disorder prior authorization tips, hospital retrospective review recommendations and how to appeal a retrospective review denial Read More . . .

OHA Releases Brief on CMS Proposed FY 2019 Inpatient Prospective Payment System Rule


CMS on April 24 issued its Proposed Fiscal Year 2019 Medicare Inpatient Prospective Payment System, or IPPS, Rule update. The rule proposes to increase inpatient operating rates by 1.75 percent and continue to push many of the administration’s health care promises such as reduction of administrative burden, focus on interopera Read More . . .

ODM Reports Issues with Medicare/Medicaid Secondary Claims Processing


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 . . .

CMS Proposes FY 2019 Rule for Inpatient Psychiatric Facility PPS


The Centers for Medicare & Medicaid Services on April 27 issued its proposed rule to update payment rates for inpatient psychiatric facilities for fiscal year 2019. CMS proposes a net payment increase of 0.98 percent over payments in FY 2018. This includes a 2.8 percent market-basket update, minus 0.8 percent for productivity an Read More . . .

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