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

Medicare Releases Hospital FAQ on Billing 340B Modifiers


The Centers for Medicare & Medicaid Services on Dec. 13 released Frequently Asked Questions that clarify its new modifier policy for billing 340B-acquired drugs under the outpatient prospective payment system. CMS requires all 340B hospitals begin using one of two new payment modifiers Jan. 1, 2018 as part of its Read More . . .

New Medicare Cards to Start Rolling Out in April


CMS continues with plans to replace all Health Insurance Claim Numbers and old Medicare cards with new Medicare beneficiary identifiers on cards over a 12-month rollout beginning April 1, 2018. The Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, requires CMS to remove Social Security Numbers from all Medicare ca Read More . . .

ICD-10 Codes Required on Outpatient Prescriptions for Opiates Beginning Dec. 29


The Ohio State Pharmacy Board recently finalized a new rule (4729-5-30(B)(14)) requiring prescribers to include the first four characters of the medical diagnosis code (ICD-10) on all prescriptions for controlled substances, which will then be entered by the pharmacy into Ohio’s prescription drug monitoring program, OARRS. Add Read More . . .

All InHealth Claims Must Be Submitted by Dec. 31


Dec. 31 is the deadline for health care providers to submit outstanding claims with Coordinated Health Mutual, Inc., or InHealth Mutual as the company was marketed on the insurance exchange, as part of the liquidation order issued by the Franklin County Common Pleas Court.The court determined on May 26, 2016 that the insurer was ins Read More . . .

OHA Finance Committee Studies Franchise Fee Reforms


For the better part of this year, the OHA Finance Committee has examined challenges presented by the existing franchise fee – growing fees resulting from hospital expense growth, shrinking traditional Medicaid caseloads that lead to shrinking Upper Payment Limit payments and new federal policies preventing the expans Read More . . .

ODM Makes Adjustment on Nov. 9 Remittance Advice


The Ohio Department of Medicaid processed a mass adjustment that appeared on the remittance advices for Nov. 9. The purpose of the mass adjustment was to correct an issue where MITS was not appropriately deciding when to pay using their standard DRG payment logic or to use the per diem based logic. The claims selected were claims wi Read More . . .

OHA's EAPG & Biennium Budget Monitoring Project Update


OHA and corporate partner BKD continue to work with member hospitals in securing agreements for the EAPG & Biennium Budget Monitoring Project for state fiscal years 2018 and 2019.  If you would like to participate in the Base Package, please notify Shawn Stack ( \if you haven’t Read More . . .

Transparency Lawsuit Hearing Delayed, New Legislation Introduced


The Williams County Court of Common Pleas announced the preliminary injunction hearing regarding OHA’s challenge to the price transparency law is delayed from Dec. 20-21 to March 15-16, 2018. The judge indicated that he needs more time to process briefs related to State Rep. Jim Butler’s motion to intervene in the lawsui Read More . . .

CMS Announces Medicare Premiums, Deductibles for CY 2018


Adding to the list of calendar year 2018 Medicare program updates announced this month, the Centers for Medicare & Medicaid Services announced its Medicare Part A deductible for inpatient hospital services will increase by $24 in calendar year 2018, to $1,340. The Part A daily coinsurance amounts will be $335 for days 61-90 of h Read More . . .

New Medicare Online Program Allows Providers to Schedule Educational Sessions


Medicare’s Quality Improvement Organization, KEPRO, now allows hospital providers to schedule a Short Stay review education session when hospitals receive an initial determination letter with a major concern. Access the online tool to schedule a session here. Read More . . .

Forms for Medicare Beneficiary Notices Initiative in Effect


Reminder that adoption of Medicare’s revised forms for the CMS Beneficiary Notices Initiative, or BNI, were required as of Aug. 28, 2017. Please make certain your teams have updated any old forms to the revised version. A link to all revised forms can be found here. Read More . . .

Review New Processes for Comprehensive Error Rate Testing (CERT) Program


OHA reminds providers to please review the new processes in the Comprehensive Error Rate Testing (CERT) Program that are outlined on CGS’s CERT page located here. Providers also should take note of the CERT Claim Identifier Tool. Providers may contact CGS CERT Coordinator, Julene Lienard at:Phone: 615.782.4591Fax: 615.664.5961 Read More . . .

No Medicaid Rate Cut for Ohio Hospitals in SFY 2018


The Ohio Department of Medicaid on Nov. 13 confirmed to OHA that the department will be withdrawing the 5 percent rate cut rule it submitted on Oct. 17 and will not cut hospital rates for the remainder of state fiscal year 2018.   “OHA appreciates the willingness of the Kasich Administration and Ohio’s General Ass Read More . . .

2018 Final Medicare Outpatient Prospective Payment System Rule Analyzed


Earlier this month, the Centers for Medicare & Medicaid Services issued the 2018 outpatient prospective payment system/ambulatory surgical center final rule. In addition to standard updates, the rule implements significant cuts to non-exempted services furnished in off-campus provider-based departments and to nonpass-throug Read More . . .

ODM Fee-for-Service Advisory Notice on ERA Dated Nov. 9


The Ohio Hospital Association has been following up with Ohio Department of Medicaid’s Hospital Policy Team this week on the credit balances that were posted to Ohio Medicaid’s Nov. 9 remit, creating large credit balances for many hospitals.  ODM released the following notice this afternoon regarding that remit aft Read More . . .

OHA Publishes Overview of the Ohio Medicaid Hospital EAPG & Biennium Budget Update and Monitoring Resources


An archive recording of the Nov. 9 OHA Health Economics & Policy webinar "Overview of the Ohio Medicaid Hospital EAPG & Biennium Budget Update and Monitoring” is available here. A copy of the PowerPoint is available here. Read More . . .

OHA Publishes BWC’s Proposed 2018 OPPS Rule Resources


An archive recording of the Nov. 2 OHA Health Economics & Policy webinar "Overview of the Bureau of Workers’ Compensation’s Proposed 2018 OPPS Rule and A Hospital Guide to Unraveling Complex Workers’ Compensation Cases and ICD-10” is available here. A copy of the PowerPoint is available here.   Read More . . .

ODM Updates Ohio Medicaid’s 340B ‘SE’ Modifier Implementation Date for Hospital 340B Entities


The Ohio Department of Medicaid’s policy team announced in a notification to OHA on Nov. 7 that all 340B entities that bill on a hospital outpatient UB04 will be required to bill an SE modifier on all 340B drug lines provided in an outpatient setting beginning Jan. 1, 2018, a delay from the requirement that was stated to Read More . . .

CMS Issues MACRA, Physician Payment Rules


The Centers for Medicare & Medicaid Services on Thursday issued its final rule for the physician fee schedule for calendar year 2018. CMS estimates a 0.41 percent increase in physician payment rates for 2018 compared to 2017. In addition, CMS makes changes to its policies implementing the site-neutral provisions that requir Read More . . .

House Passes CHIP Extension, Medicaid DSH Relief


The U.S. House voted 242-174 on Nov. 3 to pass a five-year funding extension for the Children's Health Insurance Program, which expired in September. But partisan disputes over funding offsets leave it unclear when legislation to reauthorize the popular program will actually be signed into law. The Championi Read More . . .

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