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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 Finalizes Home Health Rules, Beneficiary Protections

01/31/2017

The Centers for Medicare & Medicaid Services finalized rules governing home health agencies that will improve the quality of health care services for Medicare and Medicaid patients and strengthen patients’ rights. These Medicare and Medicaid Conditions of Participation are the minimum health and safety standards a home hea Read More . . .

Hearing Date Extended in Price Transparency Lawsuit

01/31/2017

Judge J.T. Stelzer of the Common Pleas Court of Williams County, Ohio extended the preliminary injunction hearing date from Jan. 20 to March 17 in the lawsuit filed in December to enjoin Ohio's price transparency law from going into effect. This order means the price transparency law will not go into effect, if it goes into eff Read More . . .

CMS Posts Final Hospital MOON Form Instructions

01/31/2017

CMS released its Medicare Outpatient Observation Notice, known as MOON, CMS-10611, form instructions. MOON is a standard notice that all hospitals and critical access hospitals must provide effective March 6, to all Medicare beneficiaries who receive outpatient observation services for more than 24 hours. Under the Notice of Observ Read More . . .

CareSource Increasing Outreach OB Payment, Clinical Edit Policies

01/31/2017

CareSource reported to OHA that it has kicked off a plan to engage provider partners and key provider trade associations. The focus of this plan is to acknowledge challenges over the last couple of years, provide concrete actions that have been put in place to permanently address these issues, and overall strengthen the trust and re Read More . . .

CMS Releases Guidance on Site-Neutral Payment Policy

01/31/2017

CMS released two documents that further clarify the site-neutral payment policy for hospital off-campus provider-based departments. Both the 21st Century Cures Act Sections 16001 and 16002 and the Extraordinary Circumstance Relocation Exception Guidance provide clarity around mid-build provisions as well as “extraordinary circ Read More . . .

State Shares 2017 Expectations for SIM

01/31/2017

The Governor’s Office of Health Innovation continues to develop and implement episodes of care as part of the State Innovation Model grant and Ohio’s efforts toward payment reform. OHT held a webinar Dec. 19 to give an update on progress to date and what to expect in 2017. Most notably, spend thresholds have been set for Read More . . .

OHA Releases 2016 HCAP Model, ODM Mails Assessment Letters

01/31/2017

The Ohio Department of Medicaid and OHA have agreed on the final preliminary model for 2016 HCAP. That model can be found here. Assessment letters were mailed by ODM on Jan. 9, and assessments are due in two installments on Jan. 25 and Feb. 8. Upon receipt of hospital assessments, ODM will make HCAP payments in two installments on Read More . . .

Hold the Dates - January 2017

01/31/2017

Save Thursday, Feb. 23 from 11a.m. to 1 p.m. for an important webinar with Performant Recovery (Medicare’s Region 1 Recovery Audit Contractor), the CMS and CGS Administrators. The webinar will focus on changes to the Recovery Audit Contractor process and familiarizing providers with Performant Recovery. Registration wil Read More . . .

Just the Facts - January 2017

01/31/2017

TriWest Healthcare Alliance VA Claims Issues are Reported to be Resolved. TriWest and the VA have developed a long-term fix to their claims processing and payment backlog, and they are planning to bring all claims current by the end of January. TriWest and the VA are committing additional resources to accelerate payment to pr Read More . . .

Judge Halts Start Date for Ohio Price Transparency Law

12/30/2016

The Ohio Hospital Association and member hospital, Community Hospitals and Wellness Centers in Bryan, Ohio, joined by several other health care provider groups, filed a lawsuit Dec. 22 against the State of Ohio seeking an injunction to enjoin the price transparency law from going into effect Jan. 1, 2017. Judge J.T. Stelzer of the C Read More . . .

OHA Board Endorses Medicaid Hospital Payment Modernization Model

12/30/2016

The OHA Board of Trustees on Nov. 18 endorsed the Finance Committee’s recommendation to approve the latest financial impact model (Model 13), which resolves several program development issues, including the recovery of many managed care claims missing from the department’s files.   Ohio Medicaid continues its effo Read More . . .

CMS Posts Final Hospital Observation Notice for Implementation by March 6

12/30/2016

The Centers for Medicare & Medicaid Services posted its updated version of the Medicare Outpatient Observation Notice, a standard notice that all hospitals and critical access hospitals must provide effective March 6, 2017 to all Medicare beneficiaries who receive outpatient observation services for more than 24 hours. U Read More . . .

CMS Provides More Detail on New Medicare RAC Contracts

12/30/2016

CMS has posted the statements of work for its new Medicare Recovery Audit Contractors, a map depicting the new RAC regions and contact information for each RAC. CMS in October awarded five new Medicare RAC contracts. Three contractors will perform post-payment review of Part A and B Medicare fee-for-service claims for all pr Read More . . .

ODM To Move More Ohioans to Managed Care in January

12/30/2016

The Ohio Department of Medicaid announced plans to transition more Ohioans to Medicaid managed care beginning January 2017. Using managed care is one of the department’s core strategies for improving health outcomes for Medicaid beneficiaries and for reducing costs for taxpayers.   Currently, more than 84 percent of the Read More . . .

ODM to Introduce New Provider Requirements for 340B Drug Pricing Program

12/30/2016

ODM is preparing to introduce, for adoption, a new rule to implement the requirements of a 340B entity to inform the department that they are 340B, that they will or will not be using 340B drugs for Medicaid recipients and they will use a specific modifier when 340B drugs are used for Medicaid claims. Here is some background on the Read More . . .

CMS Finalizes Bundled Medicare Payment Models for Cardiac, Hip Fracture Care

12/30/2016

CMS this month finalized a new payment model that will bundle payments to acute care hospitals for heart attack and cardiac bypass surgery services beginning in July 2017. The final rule also expands the existing Comprehensive Care for Joint Replacement model to include other surgical treatments for hip and femur fractures beyond hi Read More . . .

CMS Announces Additional Opportunities for Clinicians Under the Quality Payment Program

12/30/2016

CMS this month announced new opportunities for clinicians to join Advanced Alternative Payment Models under the Quality Payment Program, which implements the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA.   Beginning in January, CMS will open applications for new rounds of two CMS Innovation Center models for Read More . . .

OHA Accepting Nominations for Health Care Worker of the Year, Leadership Awards

12/30/2016

Member hospitals and health systems are encouraged to nominate individuals and organizations whose achievements have enhanced and brought honor to Ohio hospitals. Nominations are due Feb. 14, 2017.   The Health Care Worker of the Year Award is presented annually to one Ohio hospital caregiver who personifies a leade Read More . . .

Hold the Dates - December 2016

12/30/2016

Save Tuesday, Jan. 10 from 10 to 11a.m. for OHA’s Health Economics & Policy webinar on MACRA: What It Means to Your Hospital and Employed Physicians. OHA is presenting the session in cooperation with BKD, LLP. Registration information will be released in early January. Save Tuesday, Feb. 14 from 10 to 11 a.m. Read More . . .

Just the Facts - December 2016

12/30/2016

CMS does not plan to finalize a proposed rule to test new models for how Medicare Part B pays for prescription drugs provided in physician offices and hospital outpatient departments. Under the current Part B reimbursement model for drugs administered by infusion or injection in doctors' offices and hospital outpatient de Read More . . .

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