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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


 

Year-End Delays for Medicaid Provider Payments

06/20/2017

The Ohio Department Of Medicaid reported that providers will receive their last payments for State Fiscal Year 2017 on Thursday, June 22. There will be two weeks of delayed provider payments (June 29 and July 6) that will be made no later than Monday, July 10, 2017 due to the Ohio Administrative Knowledge System (OAKS) processing on Read More . . .

ODM Changes List of Covered Codes for Hospitals and/or ASC’s

06/20/2017

The Ohio Department of Medicaid announced on June the department has made what it calls "a few small changes" to the list of covered codes for hospitals and/or ASC’s. The changes will be effective Aug. 1.  ODM will be posting an updated spreadsheet later this week to its website which will incorporate the follow Read More . . .

Hospital Providers Prepare for the New Aug. 1 New Target Date for the Medicaid EAPG Implementation!

06/16/2017

The Ohio Department of Medicaid updated OHA and stakeholders on June 9 that its new target date for the Medicaid EAPG Implementation is Aug. 1. ODM states the new outpatient hospital reimbursement rule, Ohio Administrative Code rule 5160-2-75, will be re-filed with JCARR on June 19 to help prepare ODM for an EAPG implementation dat Read More . . .

OHA Updates Medicaid Provider Complaint Spreadsheet Process

06/15/2017

OHA  worked with the Ohio Department of Medicaid’s Bureau of Managed Health Care to develop a user friendly provider complaint form spreadsheet. The Provider Complaint Spreadsheet can be emailed to Jessica Hughes when multiple claim ICNs are impacted by the same managed care issue. OHA and the Department requests that pr Read More . . .

ODM Announces New Utilization Review Contractor

06/15/2017

The Ohio Department of Medicaid announced on June 8 that it has awarded the Program Integrity hospital utilization review contract to Keystone Peer Review Organization, Inc., or KEPRO. KEPRO will become Ohio Medicaid’s utilization review contractor on July 1. The contract will be executed upon approval of the Controlling Read More . . .

ODM Announces New Target Date for the Medicaid EAPG Implementation

06/09/2017

The Ohio Department of Medicaid updated OHA and stakeholders today that its new target date for the Medicaid EAPG Implementation is Aug. 1. ODM said the new outpatient hospital reimbursement rule, Ohio Administrative Code rule 5160-2-75, was placed in To Be Re-filed status last week. It will be re-filed in the next several w Read More . . .

Medicaid Delays EAPG, New Implementation Date to be Announced

06/02/2017

The Ohio Department of Medicaid confirmed today at a Medicaid Large Provider Meeting that the start of its new EAPG outpatient prospective payment system will be delayed until further notice. The IPPS rebase is on schedule for July 4, 2017. ODM reports issues with the outpatient reimbursement rules surrounding behavioral health red Read More . . .

Final MACRA Updates Expected This Week

06/01/2017

The U.S. Department of Health and Human Services is expected to release its final 2018 updates to the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, this week. The new rule is predicted to ease regulatory burdens on small physician groups and include more ways for clinicians to participate in advanced alternati Read More . . .

CMS Announces Medicare Beneficiary Identifier Look-Up Tool

06/01/2017

The Centers for Medicare & Medicaid Services announced on May 30 that it plans to offer providers and beneficiaries a secure quick access tool to look-up the new Medicare Beneficiary Identifiers, or MBI, so that they may look up new Medicare subscriber IDs. The Medicare Access and CHIP Reauthorization Act of 2015, Read More . . .

ODM Revises 2017 UPL Payments

05/30/2017

The Centers for Medicare & Medicaid Services are requiring the Ohio Department of Medicaid revise the 2017 Upper Payment Limit, or UPL supplemental Medicaid hospital payments, based on the availability of new cost report data. As a result, the payments released in November 2016, unfortunately, are changing, and hospitals will re Read More . . .

ODM Updates Outpatient Hospital Behavioral Health Services Website

05/25/2017

The Ohio Department of Medicaid Policy Team on May 25 shared with OHA that updates have been posted to the department's Outpatient Hospital Behavioral Health Services website under the Departments Fee Schedule and Rates webpage. Updates to the website include: coding charts, modifiers, revenue center codes and hospital slide dec Read More . . .

OHA Launches Medicaid Provider Complaint Spreadsheet

05/25/2017

OHA  worked with the Ohio Department of Medicaid’s Bureau of Managed Health Care to develop a user friendly provider complaint form spreadsheet. The Provider Complaint Spreadsheet can be emailed to Jessica Hughes when multiple claim ICNs are impacted by the same managed care issue. OHA and the Department requests that pr Read More . . .

Hospitals’ Advocacy Efforts Continue as Budget Bill Moves to Senate

05/23/2017

Ohio's two-year operating budget is headed to the Senate after Sub. HB 49 cleared the House last week. The bill passed 58-37 mostly along party lines, although a group of conservative lawmakers voted in opposition, and a handful of Democrats lent their support. OHA has prepared a summary of hospital-related p Read More . . .

3M Offers OHA Hospitals Group Discount on EAPG Software

05/23/2017

05/19/2017    3M is offering Ohio hospitals a group discount on its Enhanced Ambulatory Patient Group classification software, which will be used in the new Ohio Medicaid outpatient prospective payment system, currently scheduled for implementation on July 1. This offer is available through Aug. 1. The discount is simi Read More . . .

CMS Delays Mandatory Comprehensive Care for Joint Replacement Model Until Jan. 1, 2018

05/19/2017

The Center for Medicare & Medicaid Services announced on May 18 that it will be further delaying the start of the CJR expansion, bundled payment model to Jan. 1, 2018. The CJR expansion was to go begin in October and will now begin on Jan. 1 along with the heart attack and cardiac bypass surgery services bundled payment program Read More . . .

CMS Issues State Innovation Waiver Checklist

05/19/2017

The Center for Medicare & Medicaid Services on May 11 published a checklist for states to apply for a Section 1332 State Innovation Waiver. This waiver allows states to “pursue innovative strategies for providing… access to high quality, affordable health coverage.” Section 1332 of the Affordable Care Act allo Read More . . .

CGS Releases Clarification On Sleep Lab Credentialing: Polysomnography, Other Sleep Studies

05/19/2017

CGS released an article May 10 clarifying the definition of a sleep disorder clinic and the credentialing requirements of sleep labs in Jurisdiction 15. CGS outlined steps providers could take to meet new credentialing requirements defined by LCD 36902, stating the MAC will work with providers through the following process belo Read More . . .

Archive Copy of April 26 Webinar-Overview of Medicare FFY 2017 IPPS Proposed Rule

05/19/2017

An archive recording of the May 9 OHA Health Economics & Policy webinar Medicare FFY 2017 Prospective Payment System Proposed Rules Overview is available here.  A copy of the PowerPoint is here.   Read More . . .

Performant Recovery: Region 1, Region 5 Update

05/19/2017

Performant Recovery’s Roxanne Cooksey, director of Healthcare Operations, and Ted Doyle, vice president, Healthcare Markets and project manager of Region Five, provided the OHA Admitting, Billing and Collection Committee with a Recovery Audit Contractor Update on May 17. Cooksey reviewed the 26 CMS approved issues for Region Read More . . .

NDC Claim Enforcement Takes Effect Jan. 1, 2018

05/19/2017

ODM 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. The data collection requirement was set forth in the Deficit Reduction Act of 2005 an Read More . . .

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