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 Open Enrollment Begins Oct. 15


As the 2019 Medicare open enrollment period approaches, Jillian Froment, director of the Ohio Department of Insurance, is encouraging Medicare beneficiaries to review their drug and health insurance coverage options and select a plan that fits their needs and budget.   The Ohio Senior Health Insurance Information Program, a d Read More . . .

OHA Comments on CY 2019 Physician Fee Schedule Proposed Rule


The Ohio Hospital Association on Sept. 10 submitted comments on the Centers for Medicare & Medicaid Services' Physician Fee Schedule proposed rule for calendar year 2019. OHA offered recommendations with respect to evaluation and management visit code changes, Part B drug reimbursement, expanding access to virtual care Read More . . .

Reminder: Use Modeling for EAPG Carve-out Payments


The Ohio Hospital Association and corporate partner BKD recently released quarter 3 reports on the impact Ohio Medicaid’s EAPG grouper has had over the past year on hospital outpatient reimbursement. In the data analysis, OHA saw several scenarios in which hospitals are not seeking reimbursement appropriately for Independently Read More . . .

ODM Releases Episode-Based Payments, CPC Updates


The Ohio Department of Medicaid in August hosted webinars to update providers on the State Innovation Model grant projects, or SIM. Ohio’s SIM program includes episode-based payments and the Ohio Comprehensive Primary Care Initiative, or CPC. Slides for the CPC webinar can be found here and the SIM webinar here. Look for Read More . . .

Myers & Stauffer Updates Patient Log Template


Myers & Stauffer updated the Patient Log Template for the 2016 federal DSH audit in the following ways: Log 10 tab: clarification has been added that charges on this log should correspond with charges reported on Schedule J6 of the Medicaid cost report.New tabs: “Rev Code Crosswalk Instructions” and “Reve Read More . . .

Register for OHA’s Ohio Bureau of Workers’ Compensation 2019 IPPS Webinar


Join the Ohio Hospital Association, the Ohio Bureau of Workers’ Compensation and Argos Health Company at 10 a.m. Sept. 18 for a review of the proposed 2019 hospital inpatient reimbursement and policies and best practices in BWC billing and coding.The webinar is free to OHA members. OHA recommends this session for hos Read More . . .

OHA Publishes Final FFY 2019 Medicare IRF Payment Rule Brief


The final federal fiscal year 2019 payment rule for the Medicare Inpatient Rehabilitation Facility Payment System, or IRF, was released  Aug. 6. The final rule reflects the annual update to the Medicare fee-for-service IRF payment rates and policies. The final rule confirms:  The IRF Standard Payment Conversion Factor up Read More . . .

Register Today for ODM’s Ohio Comprehensive Primary Care Webinar


The Ohio Department of Medicaid will host a webinar about the Ohio Comprehensive Primary Care program at 11:30 a.m. Aug. 30 at 11:30. This webinar will include general information about Ohio CPC, as well as details about changes to the program for 2019 and information about upcoming enrollment.  Click here to register. After r Read More . . .

ODM Releases Updated APR-DRG Relative Weights


The Ohio Department of Medicaid’s Hospital Policy Department on Aug. 16 released Ohio Medicaid’s inpatient relative weights for hospitals . The APR-DRG relative weight table is effective for hospital inpatient Medicaid discharges on or after Sept. 1, 2018 and can be accessed here. Read More . . .

ODM Offers Webinar Series on Episodes, Register Today


The Ohio Department of Medicaid is hosting a series of webinars on episodes. These webinars will cover a variety of topics that may be useful for principal accountable providers:   Wednesday, Aug. 29, 10-11 a.m. – Update on the Episodes programWednesday, Sept. 26, 10-11 a.m. – Update on Episode reportsTuesday Read More . . .

Archive Copy: Aug. 14 OHA KEPRO Retrospective Claims Review Update Webinar


OHA’s Health Economics & Policy team on Aug. 14 hosted a webinar, "KEPRO Retrospective Claims Review Update." An archive recording of the webinar is available here along with a copy of the KEPRO presentation.   Please contact with questions. Read More . . .

OHA Publishes Final FFY 2019 Medicare IPF Payment Rule Brief


The final calendar year 2019 payment rule for the Medicare Inpatient Psychiatric Facility Payment System, or IPF, was released  Aug. 6. The final rule reflects the annual update to the Medicare fee-for-service IPF payment rates and policies. The final rule includes:  An overall rate increase amount +1.5 precentMultiple a Read More . . .

Comments Due by Aug. 22 on Proposed ODM Rule on Release of Medical Information


The Ohio Hospital Association is seeking comments on the Ohio Department of Medicaid's new proposed rule and Standard Authorization Forms for the release of medical information from covered entities. For the past several months, the Governor's Office of Health Transformation and ODM have been working on an initiative to cre Read More . . .

Ohio Medicaid Updates Outpatient Hospital Behavioral Health Diagnosis Code List Online


The Ohio Department of Medicaid’s Policy Team rolled out an updated diagnosis code list today. The new list located here, with a revision date of Aug. 10, 2018, includes a number of new ICD-10CM codes the department updated to be acceptable when providing and billing outpatient hospital behavioral health services. Read More . . .

CareSource Continues Focus on Operational Updates to OHA


CareSource leadership on Aug. 9 provided further updates on a comprehensive list of outstanding issues OHA has been working on with Ohio’s largest Medicaid managed care payer. The core issues include claim processing breakdowns, covered service discrepancies, inappropriate denials, authorization issues surrounding medical Read More . . .

2018 HCAP Delay


OHA has been informed by the Ohio Department of Medicaid that assessments and distributions for 2018 HCAP are expected to be delayed until mid-November. The delay is the result of the rule change for rural designation - a hospital will only be considered rural if it exists in a rural county. ODM does not have new dates for assessmen Read More . . .

Member Alert - OHA Transparency Update


The Ohio Hospital Association filed a lawsuit in December 2016 to prevent an unworkable state law imposing new hospital price transparency requirements from becoming effective in January 2017. To date, OHA has succeeded in preventing the law from going into effect.  The initial court order issued on Dec. 22, 2016 preventing th Read More . . .

Don’t Miss OHA’s Annual Medicare, Medicaid Update Seminar


Hospital executives, in-house counsel, auditors, controllers and reimbursement and patient financial services team members are invited to attend the “Medicare and Medicaid in 2019” seminar Sept. 20 in Columbus. Please note this seminar was formerly known as the Larry and Larry Show.   Each fall, OHA presents a sem Read More . . .

OHA Publishes Final CY 2019 Medicare IPPS Payment Rule Brief


The final calendar year 2019 payment rule for the Medicare Inpatient Prospective Payment System was released on Aug. 2. The proposed rule includes annual updates to the Medicare fee-for-service inpatient payment rates as well as regulations that implement new policies. The proposed rule includes:   A rate increase amount (+0. Read More . . .

CMS Releases Final FY 2019 Hospital IPPS Rule


The Centers for Medicare & Medicaid Services released its Hospital Inpatient Prospective Payment System final rule for fiscal year 2019 on Aug. 2. The rule will increase rates by 1.85 percent in FY 2019 compared to FY 2018, after accounting for inflation and other adjustments required by law. The final rule includes an ini Read More . . .

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