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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
 

340B Case Continues, AHA Outlines Medicare Appeals Instructions for Hospitals

01/17/2019

U.S. District Court for the District of Columbia on Dec. 27 issued an order in favor of the American Hospital Association and the other plaintiffs in the lawsuit to stop the Centers for Medicare & Medicaid Services' nearly 30 percent reduction in the reimbursement rate for 340B drugs as exceeding the statutory authority of t Read More . . .

OHA’s Admitting, Billing & Collection Committee Meets with CareSource on Operational Updates

01/17/2019

CareSource leadership on Jan. 16 provided updates to OHA’s Admitting, Billing & Collection Committee on a list of outstanding issues OHA has been monitoring and pushing for resolution on with the Medicaid managed care payer. Following the plan’s status update to committee members, OHA and the committee reviewed addi Read More . . .

Archive Copy: Jan. 15 Ohio Medicaid Updates for 2019: Fee-for-Service & Managed Care Webinar.

01/16/2019

On Jan. 15, OHA’s Health Economics & Policy team and corporate partner BKD hosted a webinar, "Ohio Medicaid Updates for 2019: Fee-for-Service & Managed Care." An archive recording of the webinar is available here along with a copy of OHA’s and BKD’s presentation. Please contact Shawn Stack w Read More . . .

Archive Copy: Jan. 15 New Standard Authorization Forms Webinar

01/16/2019

OHA on Jan. 15 hosted a webinar, "The Ohio Department of Medicaid’s New Standard Authorization Forms." An archive recording of the webinar is available here along with a copy of OHA’s presentation. The final rule and related appendices containing the Standard Authorization Forms are available here. Pleas Read More . . .

Clinical Diagnostic Laboratories to Collect, Report Private Payer Rates Call

01/15/2019

Hospital staff responsible for outreach laboratories and clinical diagnostic laboratories may register here for the Medicare Learning Network Call regarding CMS required data submissions that will be effective for tracking data beginning Jan. 1, 2021. The call is scheduled for 2-3 p.m. ET, Tuesday, Jan. 22. Does your hospital need Read More . . .

Ohio Medicaid Fee-for-Service and Managed Care 2019 HCPCs/CPT Code Updates Status’

01/15/2019

Every year, providers and payers alike are very busy updating diagnosis, CPT and HCPCS codes so services can be timely and appropriately billed and processed. OHA has reached out to Ohio Medicaid and the Medicaid Managed Care plans to provide the following update on their readiness to accept code changes:Fee for Service states that Read More . . .

CMS Activating Systematic Validation Edits for OPPS Providers with Multiple Service Locations

01/14/2019

The Centers for Medicare & Medicaid Services  announced in October that the agency will be activating systematic validation edits  for the enforcement of requirements in the Medicare Claims Processing Manual, Chapter 1, and section 170 which describes Payment Bases for Institutional Claims. Providers should make c Read More . . .

2018 HCAP 2nd Distribution Reduction

01/14/2019

Due to unpaid assessments from two hospitals, ODM has reduced the size of the second HCAP assessment which is set to be paid today, Jan. 14. In total, the reduction will be $695,311.19, which will wind up being a relatively modest reduction for individual hospitals receiving distributions. After the missing assessments are paid, ODM Read More . . .

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

01/09/2019

A new federal rule went into effect Jan. 1 that requires hospitals to post their “standard charges” on the hospital’s website in a “machine readable” format. OHA in November sent a toolkit to hospital members to assist in understanding the rule’s requirements and communicating with patients and th Read More . . .

CMS Suspends Medicaid DSH Policy During Appeal

01/07/2019

The Centers for Medicare & Medicaid Services withdrew FAQ 33 and FAQ 34, which was the 2010 policy that includes private and Medicare payments when calculating the Medicaid shortfall component for hospital-specific limit on disproportionate share payments. CMS is accepting revised DSH audits that cover hospitals services submit Read More . . .

Exchange Plan Enrollment Down Slightly

01/04/2019

Nationwide, 8.4 million people enrolled or automatically re-enrolled in a health plan through HealthCare.gov during the 2019 open enrollment period, the Centers for Medicare & Medicaid Services announced Jan. 3. Enrollment is down from last year’s 8.7 million. New consumers accounted for 25 percent of enrollment in 2019. Read More . . .

Registration Open for OHA Webinar on New Standard Authorization Forms Required by Ohio

01/04/2019

Join the Ohio Hospital Association on Jan. 15 from Noon – 1 p.m. to walk through the final rule and Standard Authorization Forms required by the Ohio Department of Medicaid. For the past several months, OHA has been working with members and providing feedback to the Governor's Office of Health Transformation and Ohio Depa Read More . . .

IRS Releases New Guidance for Tax-exempt Employers on the ‘Parking Tax’

01/03/2019

The IRS in December released preliminary guidance, NOTICES 2018-99 and 2018-100, regarding the “parking tax,” which taxes exempt employers on the expenses incurred in providing either parking or transit passes to their employees. This provision converts applicable expenses into unrelated business taxable income. Because Read More . . .

New 2019 Medicare QPP Resources Available

01/02/2019

To help hospitals prepare for the 2019 performance year of the Merit-based Incentive Payment System, or MIPS, the Center for Medicare & Medicaid Services posted the following new resources to the Quality Payment Program Resource Library. 2019 Medicare Part B Claims Measure Specifications and Supporting Documents - Provides co Read More . . .

Reminder: Confirm MIPS Virtual Group Elections for 2019, QPP Exception Applications

01/02/2019

CMS reminds providers to confirm your applications to form a virtual group for the 2019 Merit-based Incentive Payment System, or MIPS, performance year. The deadline to submit your election to CMS via e-mail was Dec. 31, 2018. To learn more about the election process and how to participate in MIPS as a virtual group in 201 Read More . . .

Ohio Medicaid Publishes 2019 Hospital Rates

01/02/2019

The Ohio Department of Medicaid posted its 2019 rate updates the last week of December 2018. The new updated rates, effective Jan. 1, are hospital inpatient base rates, inpatient capital rates, medical education rates, MCO capital rates and outpatient base rates. The rate tables can be found here on the agency’s website. OHA Read More . . .

ODM Announces Changes to PPR Program

12/28/2018

OHA members brought concerns about the Potentially Preventable Readmission or PPR program to the attention of the Ohio Department of Medicaid earlier this year. As a result, ODM worked with the contractors and 3M to resolve inconsistencies in the logic of the mental health risk adjustment and transfers. Please see ODM’s white Read More . . .

ODM Corrects Issues with IMD Involuntary Admissions

12/28/2018

With the carve-in of behavioral health into managed care this year, many issues have arisen. Recently, OHA discovered that ODM had instructed the plans to deny involuntary admissions to Institutions of Mental Disease, or IMD. OHA raised the issue to ODM, which then sought clarification from CMS and learned that denying these claims Read More . . .

ODM Delays Episode Reports, Makes Changes for 2019

12/28/2018

The Ohio Department of Medicaid announced that the episode-based payment reports due to be released in the MITS portal in October are due to be released in December.   Also, ODM is making changes to the episode-based payment program in 2019. ODM adopted a pooled approach to assess providers at the all-Medicaid view. Threshold Read More . . .

Court Rules HHS's Payment Cut for 340B Hospitals Unlawful

12/27/2018

A federal judge on Dec. 27 ruled in favor of the American Hospital Association and hospital plaintiffs saying that the U.S. Department of Health and Human Services "adjustment" by nearly 30 percent of 2018 Medicare payment rates for many hospitals in the 340B Drug Pricing Program was unlawful. The lawsuit argued that the Read More . . .

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