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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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CMS Releases FY 2019 IPPS Proposed Rule

04/30/2018

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

CMS Proposes FY 2019 Rule for Inpatient Psychiatric Facility PPS

04/30/2018

The Centers for Medicare & Medicaid Services on May 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 and Read More . . .

CMS Releases the Proposed FY 2019 Rule for Inpatient Rehabilitation Facilities, Skilled Nursing Facilities, Hospice

04/30/2018

The Centers for Medicare & Medicaid Services issued its FY2019 proposed IRF rule to update payment rates for inpatient rehabilitation facilities. CMS proposes a net payment increase of 0.9 percent over payments in FY 2018. The overall update to the payment rate includes a 2.9 percent market-basket update, minus 0.8 per Read More . . .

OHA Partners with Stakeholders to Address Behavioral Health Parity

04/30/2018

Parity@10 is a three-year campaign to establish effective models for robust enforcement of the Mental Health Parity and Addiction Equity Act in 10 states, including Ohio, and to disseminate those models across the country. The campaign’s goal is to ensure insurance carriers and state Medicaid programs offer fully parity c Read More . . .

Ohio Medicaid Delays Effective Date of Proposed Recalibration, Continues Dialogue with OHA

04/30/2018

The Ohio Department of Medicaid last month announced a proposal to recalibrate Medicaid relative weights (both APR-DRG and EAPG). ODM shared a fiscal analysis of the recalibration, which indicated this would reduce hospital payments by $84.4 million per year using 100 percent of fee-for-service pricing, and OHA hosted a March 2 Read More . . .

EAPG, Budget Monitoring Project Quarterly Reports Releasing Soon

04/30/2018

OHA has been working closely over the past few months with interested hospitals to participate in the EAPG and Ohio Medicaid budget monitoring project. OHA and BKD are on schedule to produce summary reporting for the first two quarters of monitoring later this month and will be reaching out to participating hospitals to share result Read More . . .

Important Dates for 2018 HCAP

04/30/2018

The second and final 30-day window for all hospitals to revise their cost report data opens today. This will be the last time hospitals will have a chance to revise their SFY 2017 cost report data before the cost reports are considered closed. If a hospital wishes to revise its data in this 30-day window, it will be assessed an admi Read More . . .

Senate Committee Took Up 2 New Health Bills in April

04/30/2018

Barbara Sears, director, Ohio Department of Medicaid, presented an update on behavioral health integration and the Medicaid budget earlier this month in a meeting with the Joint Medicaid Oversight Committee, and the Senate Health, Human Services & Medicaid Committee held first hearings on bills to establish drug and medical equi Read More . . .

OHA Reminds Hospitals of Medicaid Reimbursement for Private Rooms

04/30/2018

While Ohio Medicaid allows reimbursement for private rooms, OHA has learned many providers are not seeking reimbursement by billing for the services on claims under the following conditions:   When a private room is medically necessaryWhen a hospital has no semi-private roomWhen the patient chooses a private room and agrees, Read More . . .

ODM Identifies Glitch in March Newborn Enrollment

04/30/2018

OHA received confirmation from the Ohio Department of Medicaid that approximately 2,500 newborns were not enrolled in their mother’s managed care plan for their date of birth if they were both born and scheduled to be enrolled during the month of March. ODM identified the system glitch affecting this population and fixed the p Read More . . .

Reminder: Review BWC 2018 OPPS Final Rule Details

04/30/2018

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 . . .

Hold the Dates - April 2018

04/30/2018

June 4-6 – The 103rd OHA Annual Meeting and Education Summit - Join members of the Ohio hospital community June 4-6 in Columbus for the 103rd Annual Meeting and Education Summit. The three-day event features more than 80 education sessions, keynote presentations by national leaders and special recognition events. The conferenc Read More . . .

Just the Facts - April 2018

04/30/2018

CMS Releases FAQ on 340B: CMS on April 2 released a seven-page 340B fact sheet that clarifies the $1.6 billion in cuts and how to properly bill using the JG and TB on 340B drugs. The FAQ outlines specific directives impacting 340B reimbursement, depending on each hospital’s Medicare hospital type designation and if h Read More . . .

Ohio Medicaid Proposes Hospital Inpatient, Outpatient Recalibration

03/30/2018

During a March 22 meeting with OHA's team, Ohio Department of Medicaid staff and department consultants from Burns & Associates outlined their proposal to recalibrate Medicaid relative weights (both APR-DRG and EAPG weights) to be effective July 1. They also shared a fiscal analysis of the recalibration, which indicated Read More . . .

OHA Group Defines Metrics to Measure Telehealth Effectiveness

03/30/2018

As evidenced by the successful innovation and intervention happening in hospitals across our state, telehealth is providing increased access to care, lowering costs and improving patient satisfaction and clinical outcomes for Ohioans. However, according to the new Hospital Insights published by the Ohio Hospital Association, there a Read More . . .

Ohio SIM: Episode Based Payment Updates

03/30/2018

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 . . .

Ohio Medicaid Restructuring Provider Payment Cycles

03/30/2018

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 . . .

Buckeye Health Plan Updates on Behavioral Health, EAPGs, TeleHealth

03/30/2018

Buckeye Health Plan met with OHA’s Admitting, Billing & Collection Committee on March 21 and presented updates on Buckeye’s continued focus to support the state of Ohio through multiple product lines: Medicaid, Medicare, MyCare, Ambetter and Medicare Advantage products. Buckeye updated the ABC Committee on the statu Read More . . .

MITS Fixes In Place

03/30/2018

The Ohio Department of Medicaid updated OHA that the following MITS fixes were implemented on March 21. ODM amended:   Incorrect duplicate denials within and across dates of service for pharmaceutical details on outpatient invoice claimsOutpatient crossover claims are not correctly calculating reimbursement when Medicaid is t Read More . . .

ODM Guidelines for Hysterectomy, Sterilization, Abortion Certification Forms Published

03/30/2018

The Ohio Department of Medicaid on March 14 published its guidance to complete:   DM 03197, Abortion Certification FormODM 03199, Acknowledgement of Hysterectomy InformationU.S. Department of Health and Human Services Form HHS-687, Consent for Sterilization Click here for the guidance information. The revised forms Read More . . .

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