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

Overview of KEPRO: ODM Retrospective Claims Review Webinar Materials Published


An archive recording of the Oct. 10 OHA Health Economics & Policy webinar "KEPRO: ODM Retrospective Claims Review Webinar" is available here. A copy of the PowerPoint is available here. A copy of the Q&A document is available here.   Read More . . .

ODM Rate Cut Rule Filed


As expected, the Ohio Department of Medicaid yesterday filed the rule implementing a 5 percent hospital rate cut.   See the rule, the public notice, and other documents here.   Note that the public hearing and deadline for written comments is Nov. 17. OHA plans to oppose this rule.   OHA will be in touch with mo Read More . . .

OHA Releases Patient Education Letter Template In Response to Anthem’s Radiologic Policies


The Ohio Hospital Association today released a patient communication template hospitals can use to communicate with patients impacted by Anthem BCBS’s new outpatient radiologic policy implemented in Ohio on Sept. 1.   The template  assists hospitals in explaining the benefits patients may want to consider when Read More . . .

OHA Releases Preliminary Hospital-Specific 2018 UPL Payment Data


OHA has posted the projected 2018 Upper Payment Limit amounts due to hospitals here. UPLs were calculated in this preliminary run to be $488.3 million statewide, which is $50 million (or 9.3 percent) lower than SFY 2017 payments. Most hospitals will see a decline due to continued erosion of traditional Medicaid fee-for-service volu Read More . . .

Slides from Sept. 21 Episode Based Payment Webinar


ODM hosted its monthly Episode Based Payment Webinar on Sept. 21. The slides for that webinar can be found here. The next SIM Episode Based Payment webinar will be 10 a.m. Thursday, Oct. 19. Please contact Aly DeAngelo with any questions. Read More . . .

Don't Miss Medicare’s Open Enrollment Period Oct. 15 – Dec. 7


Medicare health and drug plans can make changes each year on cost, coverage, network providers and pharmacies. All enrollees in Medicare can change their health plans and prescription drug coverage for 2018 to better meet their personal needs between Oct. 15 to Dec. 7.Please make certain hospital registration staff are aware of this Read More . . .

CMS Quality Payment Program Fall Series Begins


If you are affiliated with a hospital or provider and interested in learning more about the Quality Payment Program, the Centers for Medicare & Medicaid Services fall educational series has started. For general QPP information, click here. CMS fall educational schedule:  QPP MIPS: Pick your PACE - 1 p.m. (CT) Sept. 2 Read More . . .

CareSource Shows Good-Faith In Resolving Claims Issues


Ohio Hospital Association representatives met with CareSource’s Ohio president, vice president of Ohio Market Operations and Ohio Government Affairs director Oct. 3 in Columbus to talk through CareSource’s plan to address communication and claims issues that have been impacting payments and taxing administrative resource Read More . . .

OHA Meeting with State Leaders on 2 Critical Medicaid Payment Issues


The Ohio Hospital Association, along with other provider associations, met Thursday with the directors of the Governor's Office of Health Transformation and the Ohio Department of Medicaid as well as a representative from the Governor's office to hear updates on plans to move forward on two issues of key importance to the ho Read More . . .

CMS Issues Instructions for Worksheet S-10


CMS issued new and revised instructions for charity care and bad debt data reported by hospitals on worksheet S-10 of the Medicare Cost Report.This data is now used for the distribution of Medicare Disproportionate Share Hospital, or DSH, funding. See this Medicare Learning Network (MLN) document from CMS, intended to hel Read More . . .

Ohio AG Office Begins Reimbursement for HIV Prophylaxis Under SAFE Program


The Ohio Attorney General’s Office on Oct. 3 began reimbursing for HIV Prophylaxis as part of the Sexual Assault Forensic Exam Program. In July 2017, the Ohio legislature approved language within the SAFE statute to add payment for HIV prophylaxis when directly related to a sexual assault and done in conjunction with forensic Read More . . .

Don't Forget: Medicare Beneficiary Identifier Begins April 1, 2018


The Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, requires Centers for Medicare & Medicaid Services to remove Social Security Numbers from all Medicare cards by April 2019. CMS will respond with randomly generated Medicare Beneficiary Identifiers starting next spring. Medicare identifiers will replace the Heal Read More . . .

OHA Group Secures ODM Agreement to Revisit Cuts, But State Officials Can’t Explain Projected Shortfall


A group of Ohio hospital leaders led by OHA Board Chair Kevin Webb (ProMedica) and Chair-elect Bruce White (Knox Community Hospital) met with Ohio Department of Medicaid actuaries and staff on Sept. 18 to press for the rationale behind $690 million in additional hospital cuts announced after the state budget was approved end of June Read More . . .

OHA Demands Anthem Rescind New Imaging Policies


The Ohio Hospital Association, through legal counsel Bricker & Eckler LLP, has demanded Anthem rescind its adoption of a retroactive review process of the medical necessity of all MRIs and certain CT scans performed in hospital emergency departments and dually pending claims for clinical reviews billed with high-tech imagin Read More . . .

CMS Extends Deadline for S-10 Reporting Changes to Oct. 31


The Centers for Medicare & Medicaid Services notified the Ohio Hospital Association it has extended the window for hospitals to amend uncompensated care, bad debt, and other Worksheet S-10 reporting on their fiscal year 2014 and 2015 Medicare cost reports from Sept. 30 to Oct. 31. Please remember proper reporting of data on Wor Read More . . .

ODM Confirms 340B Hospital Outpatient Modifier Requirement for Oct. 1


Ohio Department of Medicaid’s section chief confirmed in a written statement on Sept. 27 to the Ohio Hospital Association that ODM is moving forward with its 340B modifier requirement beginning Oct. 1. Hospitals recognized as a 340B entity are required to notify Medicaid agencies when a 340B purchased drug is provided to a Me Read More . . .

Hospitals Report Success in Using ODM Provider Complaint Process


Hospitals reported to OHA in July and again in September that the complaint communication process launched over the summer is yielding positive results in resolving claim and payment issues with the Medicaid managed care plans. OHA worked with the Ohio Department of Medicaid’s Bureau of Managed Health Care to develop a u Read More . . .

Ohio Medicaid NDC Code Enforcement Takes Effect Jan. 1, 2018


The Ohio Department of Medicaid announced its required National Drug Codes for all pharmacy line items on outpatient hospital Medicaid bills with an enforcement date of Jan. 1, 2018. ODM approved the new process in August 2016 with an effective date of Jan. 1, 2017, but then delayed the enforcement date until Jan. 1, 2018 Read More . . .

Medicaid Managed Care Plans Provide Update on EAPG Implementation Delay Resolutions


The Ohio Hospital Association continues to work with the Ohio Department of Medicaid and Ohio Medicaid’s managed care plans on their processing of Medicaid claims after the EAPG implementation struggled on Aug. 1.  The following processes for each plan have been updated to reflect where plan each is n processing and Read More . . .

OHA Issues Call for 2018 Annual Meeting Presentations


The Ohio Hospital Association is seeking dynamic and engaging presentations to educate health care professionals and motivate the pursuit of excellence at the 2018 OHA Annual Meeting June 4-6 in Columbus. Representatives from member hospitals, OHA corporate partners and other health care-related organizations are invited to complete Read More . . .

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