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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
 

UHC Announces Prior Authorization for Site of Care Outpatient MR/CT Services

11/15/2018

United Healthcare in October announced in its Provider Bulletin that the payer would be requiring specific criteria be met to support medical necessity when performing advanced radiological imaging procedures in hospital outpatient departments. UHC stated said one of the following criteria must be met to perform advanced radiologic Read More . . .

OHA Provides Toolkit for Complying with New Federal Rule on Posting Standard Charges

11/12/2018

On Jan. 1, 2019 a new federal rule goes into effect that requires hospitals to post their “standard charges” on the hospital’s website in a “machine readable” format. OHA has prepared a toolkit for hospital members to assist in understanding the rule’s requirements and communicating with pati Read More . . .

2018 HCAP On Hold

11/12/2018

OHA had previously reported a start date of Nov. 14 for 2018 HCAP. This has been delayed to a date yet to be released due to the rulemaking process taking longer than the Ohio Department of Medicaid had anticipated. OHA staff has been assured by ODM that 2018 HCAP will be completed by Christmas. Read More . . .

New Medicare Card Mailing Update – Wave 6 Ends

11/12/2018

CMS finished mailing cards to people with Medicare who live in Waves 1-5 and is begining distribution in wave 6 states (Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Texas, Utah, Washington and Wyoming). Card mailing in Wave 7 states and territories continues. Ohio is in Wave 7. If someone with Medicare says they did Read More . . .

OHA Releases Brief on CMS Final CY 2019 OPPS Rule

11/09/2018

CMS on Nov. 2 published its final calendar year 2019 Medicare Outpatient Prospective Payment System Rule Update. The rule proposes to increase the OPPS Payment Rate +1.09 percent from the CY 2018 OPPS conversion factor.OHA’s Payment Rule Brief can be found at the link here. Please contact Shawn Stack with any questions. Read More . . .

Ohio BWC Seeks Comments of Proposed 2019 OPPS and ASC Rules

11/06/2018

Ohio Bureau of Workers' Compensation seeks comments through Nov. 16 on two proposed fee schedule rules. After review, OHA is preparing comments to submit on Outpatient Hospital Reimbursement Rule, Ohio Administrative Code 4123-6-37.2 to become effective May 1, 2019 and the current Ambulatory Surgical Center Services Rule, Ohio Read More . . .

CMS Releases OPPS, PFS, Home Health, QPP Fact Sheets

11/06/2018

Medicare recently published fact sheets summarizing the 2019 final rules for: Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC)Physician Fee Schedule (PFS)Home Health Prospective Payment SystemQuality Payment Program (QPP) Please contact Shawn Stack with questions.   Read More . . .

CMS Publishes Final CY 2019 Physician Fee Schedule Rule

11/02/2018

The Centers for Medicare & Medicaid Services on Nov. 1 issued its final rule updating calendar year 2019 Physician Fee Schedule. The CY 2019 Physician Fee Schedule has a conversion factor of $36.04, a small increase over the CY 2018 rate of $35.99 which also reflects a budget-neutrality adjustment required by law and an update Read More . . .

CMS Publishes Final CY 2019 Rule

11/02/2018

The Centers for Medicare & Medicaid Services on Nov. 2 issued its final rule updating calendar year 2019 Hospital Outpatient Prospective Payment, or OPPS, and Ambulatory Surgical Center, or ASC, Payment System and Quality Reporting Programs. Highlights of the final rule:Cuts payments for clinic visits in grandfat Read More . . .

The VA Choice Program

11/01/2018

The Veterans Administration announced Oct. 2 in a press release that the Triwest contract will extend and expand to cover the entire country for the Patient-Centered Community Care, PC3, and Veterans Choice Program, or VCP.  A press release fromTriWest provided more details regarding the expansion plans. TriWest stat Read More . . .

October HCAP Model Update

11/01/2018

There has been a small update to the 2018 HCAP model. Heather Hill Care Communities closed during the program year, and the model has been adjusted. Because this hospital was not going to receive a net gain, this will not substantially change the closed hospital or statewide residual pots. Data for the time when the hospital was clo Read More . . .

Ohio Medicaid: Restricted Medicaid Coverage

11/01/2018

The Ohio Department of Medicaid on Nov. 1 proposed rule 5160:1-6-06.5 on how to calculate and apply a restricted Medicaid coverage period when an institutionalized individual improperly transferred an asset. Differences between this rule and the rule it is replacing are the addition of language regarding about how to calculate Read More . . .

Federal Court Rules for Hospitals on Medicare Appeals Backlogs

11/01/2018

A federal court on Nov. 2 ruled in favor of the American Hospital Association and member hospitals to set-up deadlines to reduce the Medicare appeals backlog many providers have been experiencing. The outcome of the case requires the Department of Health and Human Services meet the following targets on the fiscal year 2018 back Read More . . .

ODM Updates Quality Metrics

10/31/2018

Reports have been delayed for an unspecified amount of time for latest round of episode-based payments, but the Ohio Department of Medicaid hosted a webinar on Oct. 23 and shared some design updates, largely in the quality metrics.   At this point, there are nine episodes tied to payment:   EpisodePrincipal Accountable Read More . . .

Member Hospitals Encouraged to Join County Stepping Up Initiative

10/31/2018

The OHA Behavioral Health Leadership Council in 2017 set a priority to work with law enforcement and the judicial system to understand the roles of these stakeholders in the bigger picture of behavioral health care in Ohio. In researching this topic, OHA joined Ohio’s Stepping Up initiative. Stepping Up is part of a nati Read More . . .

OHA Publishes Most Commonly Denied Medicaid Non-Covered Codes

10/25/2018

OHA has been working with the Ohio Department of Medicaid’s Hospital Policy Team to develop a list of commonly billed non-covered outpatient codes.   As a part of OHA’s continued outreach and education, here is a list of the most commonly billed non-covered outpatient codes and corresponding comments OHA has creat Read More . . .

CMS Omnibus on Burden Reductions Proposed Rule

10/24/2018

Join the Centers for Medicare & Medicaid Services for a tri-region webinars hosted by the chief medical officer of regions V, VI and VII. Content is the same for both webinars and will discuss changes in the Omnibus proposed rule and will include a question-and-answer session. Select your preferred date to register. Re Read More . . .

Call to Action: Pledge Support of 340B Stewardship Principles

10/22/2018

Leaders from the American Hospital Association and the AHA Advocacy Alliance for the 340B Drug Pricing Program have announced new principles for ensuring good stewardship of the 340B program and request member hospitals pledge to join the effort. This new AHA-led initiative aims to strengthen the 340B program by increasing transpar Read More . . .

New Medicare Card Mailing Update — Ohio in Current Wave

10/15/2018

CMS several weeks ago started mailing new Medicare cards to people with Medicare who live in Wave 7 states and territories including: Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Puerto Rico, Tennessee and the Virgin Islands. CMS concluded mailing cards to people with Medicare who live in states within Waves 1 throug Read More . . .

UPDATE: ODM Addressing Inappropriate Denials for Invalid NDC/HCPCS

10/15/2018

The Ohio Department of Medicaid’s Hospital Policy Team reported to OHA that, due to an oversight, edit 4891, Invalid NDC/HCPCS combination, was returned to a deny status effective Oct. 1. ODM is planning an emergency update to have the denials returned to pay/post status prior to that date.ODM confirmed on Oct. 15 that the eme Read More . . .

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