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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


 

Hearing Date Extended in Price Transparency Lawsuit

02/13/2017

Judge J.T. Stelzer of the Common Please Court of Williams County, Ohio on Jan. 17 issued an order extending 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 int Read More . . .

CMS Posts Final Hospital MOON Form Instructions

02/13/2017

The Centers for Medicare & Medicaid Services released final Medicare Outpatient Observation Notice, or MOON, CMS-10611, form instructions. The 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 mo Read More . . .

TriWest, VA Claims Issues Resolved

02/13/2017

TriWest Healthcare Allicance and the VA  developed a long-term fix to claims processing and payment backlog and are planning to bring all claims current by the end of January 2017. TriWest and the VA are committing additional resources to accelerate payment to providers and decrease the claims inventory that has built up since Read More . . .

CareSource Payment, Clinical Edit Policies Updated

02/13/2017

CareSource is developing a communication plan to engage its provider partners and key provider trade associations. The plan will address challenges of the last couple of years, provide details on concrete actions put in place to permanently address these issues, and work to sthrengthen relationships with providers.  Overview: Read More . . .

Archived Copy of Jan. 10 Health Economics and Policy Webinar

02/09/2017

An archive copy of the Jan. 10 OHA Health Economics & Policy webinar, “MACRA Final Rule Review” is available. A recording of the webinar presentation is available here. A copy of the PowerPoint is here and a copy of the Q&As is here. Read More . . .

Archived Copy of Jan. 24 Health Economics and Policy Webinar

02/09/2017

An archive copy of the Jan. 24 OHA Health Economics & Policy webinar “Introduction to 3M Enhanced Ambulatory Patient Groups EAPGs” is available. A recording of the webinar presentation is available here. A copy of the PowerPoint is here. Read More . . .

Reminder: Second HCAP Assessment Due Feb. 8

02/06/2017

This is a reminder that the second and final assessment for 2016 HCAP is due Wednesday, Febr. 8. It is imperative this assessment be paid on time so ODM can stay on schedule with the second and final payment to hospitals for 2016 HCAP. If assessments are submitted on time, the second payment will be made Monday, Feb. 20. If you hav Read More . . .

ODM on Track to Make First Payment for 2016 HCAP

02/02/2017

The Ohio Department of Medicaid confirmed to OHA on Thursday, Feb. 2 that they were on schedule to make the first round of payments to hospitals for 2016 HCAP beginning Friday, Feb. 3, 2017. The second half of the assessment is due Wednesday, Feb. 8. If all assessments are paid on time, the plan is for ODM to make the second and fi Read More . . .

HHS Updates Federal Poverty Guidelines

01/31/2017

The Department of Health and Human Services released its annual update of the Federal Poverty Guidelines on 1/31. The updated guidelines for the 48 contiguous states and the District of Columbia are as follows: Persons in family/household Poverty guideline 1 $12,060 Read More . . .

TriWest Healthcare Alliance VA Claims Issues are Reported to be Resolved!

01/27/2017

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 2017. TriWest and the VA are committing additional resources in order to accelerate payment to providers and decrease the claims inventory that has built up since A Read More . . .

CMS Guidance on the Site-Neutral Payment Policy

01/27/2017

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

01/26/2017

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 be Read More . . .

OHA Releases Final Preliminary Model for 2016 HCAP

01/11/2017

ODM and OHA have agreed on what will be the final preliminary model for 2016 HCAP. That model can be found here. Assessment letters were mailed by ODM on Friday, January 9, and assessments are due in two installments on January 25 and February 8. Upon receiving the assessments from hospitals, ODM will make HCAP payments in two insta Read More . . .

ODM Mails Assessment Letters to Hospitals

01/06/2017

OHA has been notified by ODM that assessment letters for the 2016 HCAP model are being mailed today, January 6, 2017. A generic assessment letter can be found here. Additionally, assessments each hospital can expect to pay can be found here. As the letter points out, the due date for the first installment – equivalent to one-h Read More . . .

AHA releases a special bulletin on CMS Sub-Regulatory Guidance on Implementation of Site-Neutral Payment Policy

01/06/2017

In recent weeks, the Centers for Medicare & Medicaid Services (CMS) released two important documents that further clarify the agency’s site-neutral payment policy for certain off-campus provider-based departments (PBDs) of a hospital. First, CMS released preliminary guidance regarding sections of the recently enacted 21st Read More . . .

Judge Issues Temporary Restraining Order Regarding Ohio Price Transparency Law

12/23/2016

This morning 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 against the State of Ohio seeking an injunction to enjoin the price transparency law from going into effect Jan. 1, 2017. This afternoon, Judge Read More . . .

OHA Board Endorses Latest Financial Impact Model in Ohio Medicaid’s Hospital Payment Modernization Project

12/23/2016

Ohio Medicaid continues its efforts to move from volume to value with its hospital reimbursement policies, but the process of remaking an entire hospital reimbursement system has been slower than anticipated, with implementation deferred to July 1, 2017.   ODM, through its fee-for-service program and five Medicaid managed car Read More . . .

CMS Posts Final Hospital MOON for Implementation by March 6

12/23/2016

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. Under the Read More . . .

CMS Provides More Detail on New Medicare RAC Contracts

12/23/2016

The Centers for Medicare & Medicaid Services 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 Read More . . .

ODM Transitions More Ohioans to Managed Care in January 2017

12/23/2016

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 . . .

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