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A monthly compendium of OHA finance and patient financial services policy and payment alerts.

August 2018

>>> Download the August Edition
  • Don’t Miss OHA’s Annual Medicare, Medicaid Update Seminar
  • CMS Releases Final FY 2019 Hospital IPPS Rule
  • OHA Publishes Final FFY 2019 Medicare IPF Payment Rule Brief
  • OHA Publishes Proposed CY 2019 Medicare OPPS Payment Rule Brief
  • OHA Publishes Final FFY 2019 Medicare IRF Payment Rule Brief
  • CMS Releases Final FY 2019 Hospice Rule
  • CMS Releases Final FY 2019 LTCH PPS Rule
  • OHA Transparency Update: Case on Hold Pending Procedural Ruling
  • Myers & Stauffer Updates Patient Log Template
  • Ohio Medicaid Updates Outpatient Hospital Behavioral Health Diagnosis Code List Online
  • ODM Offers Webinar Series on Episodes, Register Today
  • ODM Releases Updated APR-DRG Relative Weights
  • CareSource Continues Focus on Operational Updates Shared with OHA
  • OHA Reiterates Ohio Medicaid’s Directive to Plans Managing Transition of Care Coverage

July 2018

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  • CMS Proposes Updates to CY 2019 Hospital Outpatient Prospective Payment System
  • Proposed CY 2019 CMS Updates Released for Physician Fee Schedule, Revisions to Part B
  • CMS Proposes CY 2019 Home Health Update and CY 2020 Redesign
  • Medicare Debuts myCGS Dashboard for Providers to Track Medical Review Requests
  • CMS Updates Deadline for MIPS Review Requests
  • CMS Distribution of Ohioans' New Medicare Cards Under Way
  • CMS to Allow Participants to Withdraw from Bundled Payment Model in March
  • ODM Updates Hospital Billing Guidelines
  • CareSource Provides Operational Updates to OHA
  • OHA Reminds Hospitals of Medicaid Reimbursement for Private Rooms
  • State Promotes Parity as Behavioral Services Shift to Managed Care
  • ODM Announces Downtime to OBWP County Portal, Deemed Newborn/PE Portal

June 2018

>>> Download the June Edition
  • OHA Comments on FY 2019 IPPS Proposed Rule
  • Register Now for the OHA, FHA Annual Medicare 101 Training
  • Providers: Prepare for Ohioans with New Medicare Cards
  • ICD-10 Rule for Non-Opioid Controlled Substances Effective July 1
  • Ohio Medicaid Postpones Hospital Rate Cut
  • Update: SFY 2018 Hospital Cost Report Posted
  • Plan Now for 3M Hospital Group Update on June 27
  • ODM's Hospital Policy Team Issues Updates
  • OHA Publishes Ohio Medicaid Billing, Reimbursement FAQ
  • Reminder: Medicaid Specifies Billing for LARC Devices
  • ODM Announces Downtime to Presumptive, Deemed Eligibility Portal
  • BWC Clarifies Behavioral Health Services in New Rule

May 2018

>>> Download the May Edition
  • Federal Disproportionate Share Hospital Audit Released May 14
  • Verma Draws the Line on Medicaid Limits
  • OHA Releases Brief on CMS Proposed FY 2019 Inpatient Prospective Payment System Payment Rule
  • OHA Releases Brief on CMS Proposed FY 2019 IRF Prospective Payment System Rule
  • OHA Releases Brief on CMS Proposed FY 2019 Inpatient Psychiatric Facility Prospective Payment System Rule
  • CMS Summer Webinar Series Starts June 6
  • OHA Works with ODM to Improve Communications Through Medicaid Managed Care Contracts
  • CareSource Provides Operational Updates to OHA
  • Director Sears Provides Behavioral Health Redesign Update
  • ODM Reports Issues with Medicare/Medicaid Secondary Claims Processing
  • KEPRO Launches Quarterly KEPRO Connect Ohio Newsletter
  • Anthem Announces New Commercial Facility Reimbursement Policy
  • CGS Administrators, LLC Launches MBI Look-Up Tool

April 2018

>>> Download the April Edition
  • CMS Releases FY 2019 IPPS Proposed Rule
  • CMS Proposes FY 2019 Rule for Inpatient Psychiatric Facility PPS
  • CMS Releases the Proposed FY 2019 Rule for Inpatient Rehabilitation Facilities, Skilled Nursing Facilities, Hospice
  • OHA Partners with Stakeholders to Address Behavioral Health Parity
  • Ohio Medicaid Delays Effective Date of Proposed Recalibration, Continues Dialogue with OHA
  • EAPG, Budget Monitoring Project Quarterly Reports Releasing Soon
  • Important Dates for 2018 HCAP
  • Senate Committee Took Up 2 New Health Bills in April
  • OHA Reminds Hospitals of Medicaid Reimbursement for Private Rooms
  • ODM Identifies Glitch in March Newborn Enrollment
  • Reminder: Review BWC 2018 OPPS Final Rule Details

March 2018

>>> Download the March Edition
  • Ohio Medicaid Proposes Hospital Inpatient, Outpatient Recalibration
  • OHA Group Defines Metrics to Measure Telehealth Effectiveness
  • Ohio SIM: Episode Based Payment Updates
  • Ohio Medicaid Restructuring Provider Payment Cycles
  • Buckeye Health Plan Updates on Behavioral Health, EAPGs, TeleHealth
  • MITS Fixes In Place
  • ODM Guidelines for Hysterectomy, Sterilization, Abortion Certification Forms Published
  • CMS Begins Low Volume Appeals Settlement Process
  • CMS to Expand Patient Access to E-health Records
  • CGS Introduces Comparative Billing Report
  • Federal Court Voids CMS Rule on Medicaid DSH Audits
  • Reminder: Review BWC 2018 OPPS Final Rule Details

February 2018

>>> Download the February Edition
  • Price Transparency Lawsuit Hearing Further Delayed
  • Ohio ACA Enrollment Down Slightly for 2018
  • Federal Government Passes Short-term Spending Bill with Hospital Priorities
  • Federal Budget Tools, Presentations Available
  • Anthem’s New ER Policy: How Hospitals Can Help
  • Anthem Rescinds Modifier 25 Policy
  • Hospital Associations Urge Court to Stop 340B Payment Cut
  • CMS Invites Feedback on eCQM Draft Measure Packages
  • Medicare Hospital Attestation Deadline Extended to March 16
  • Ohio Medicaid Announces Work Requirements Proposal for Expansion Enrollees
  • Reminder: ODM's Integrity Auditor Reinstates Technical Denials
  • Ohio Medicaid’s Managed Care Plans Release Consolidated Plan Resource Guide
  • CareSource Provides Updates on Lingering Issues
  • EAPG, Budget Monitoring Project Update
  • ODM Reports on Behavioral Health Redesign to Legislature

January 2018

>>> Download the January Edition

  • Deadline Feb. 16 for Hospital Community Benefits Survey
  • OHA, OSMA Testify on Health Care Price Transparency
  • OHA Names 2018 Committee Chairs, Thanks Outgoing Leaders
  • ICD-10 Codes Required on Outpatient Prescriptions for Opiates 
  • Hospital Groups Notify Court of Appeals of 340B Case
  • Hospitals Encouraged to Appeal Denied Anthem ED Claims
  • CHIP Extended Yet Medicare Issues, Community Health Centers Still Unfunded
  • HHS Updates Federal Poverty Guidelines
  • Hospitals Advised to Educate Access Teams on New Medicare Cards Rolling Out in April
  • Medicare Therapy Cap Claims To Be Released
  • Medicare’s Quality Improvement Organization Announces New Person & Family Engagement Project
  • Medicaid Under Budget Through First 6 Months
  • ODM Vendor Reinstates Technical Denials
  • ODM Releases Preventable Re-admissions Analysis

December 2017

>>> Download the December Edition

  • ODH Publishes Community Benefit Report; Member Talking Points Provided
  • ICD-10 Codes Required on Outpatient Prescriptions for Opiates as of  Dec. 29
  • OHA Recommends Strategies in Response to Anthem Imaging Payment Policies
  • Inpatient Behavioral Health Carve-In for Managed Care Begins Jan. 1
  • Ohio Hospitals Continue to Work Through Issues with CareSource
  • Reminder: Ohio Medicaid NDC Code Enforcement Takes Effect Jan. 1
  • Ohio BWC Files 2018 OPPS Final Rule Details
  • Medicare Releases Hospital FAQ on Billing 340B Modifiers
  • New Medicare Cards to Start Rolling Out in April

November 2017

>>> Download the November Edition

  • No Medicaid Rate Cut for Ohio Hospitals in SFY 2018 
  • Transparency Lawsuit Hearing Delayed, New Legislation Introduced
  • OHA Finance Committee Studies Franchise Fee Reforms
  • OHA's EAPG & Biennium Budget Monitoring Project Update
  • 2018 Final Medicare Outpatient Prospective Payment System Rule Analyzed
  • CMS Issues MACRA, Physician Payment Rules
  • CMS Announces Medicare Premiums, Deductibles for CY 2018
  • House Passes CHIP Extension, Medicaid DSH Relief
  • ODM Updates 340B ‘SE’ Modifier Implementation Date for Hospital 340B Entities
  • ODM Makes Adjustment on Nov. 9 Remittance Advice

October 2017

>>> Download the October Edition

  • OHA Meeting with State Leaders on 2 Critical Medicaid Payment Issues 
  • ODM Rate Cut Rule Filed
  • OHA Releases Patient Education Letter Template in Response to Anthem’s Radiologic Policies
  • OHA Releases Preliminary Hospital-Specific 2018 UPL Payment Data
  • CMS Releases Correction Notice for Final FY 2018 Medicare IPPS and LTCH Update
  • CMS Issues Instructions for Worksheet S-10
  • Window Extended for Hospitals to Amend CMS Worksheet S-10 Reporting
  • CMS Quality Payment Program Fall Series Begins
  • CareSource Shows Good-Faith in Resolving Claims Issues
  • Don't Miss Medicare’s Open Enrollment Period Oct. 15 – Dec. 7
  • Don't Forget: Medicare Beneficiary Identifier Begins April 1, 2018
  • Ohio AG Office Begins Reimbursement for HIV Prophylaxis Under SAFE Program
  • OHA Issues Call for 2018 Annual Meeting Presentations

September 2017

>>> Download the September Edition

  • OHA Group Secures ODM Agreement to Revisit Cuts; State Officials Still Can’t Explain Projected Shortfall
  • OHA Demands Anthem Rescind New Imaging Policies
  • Transparency Lawsuit Hearing Delayed
  • OHA Comments on Proposed Medicare Hospital Payment System Changes for 2018
  • CMS Extends Deadline for S-10 Reporting Changes to Oct. 31
  • Don’t Wait: Part A Direct Data Entry Recertification Due by Sept. 30
  • Medicaid Managed Care Plans Provide Update on EAPG Implementation Delay Resolutions
  • ODM Confirms 340B Hospital Outpatient Modifier Requirement for Oct. 1
  • Ohio Medicaid NDC Code Enforcement Takes Effect Jan. 1, 2018
  • Reminder: New Outpatient Behavioral Health Service Codes Available
  • Medicaid FFS Billing: Omit Uncovered Charges
  • Hospitals Report Success in Using ODM Provider Complaint Process
  • Ohio CPC Extended into 2018
  • Expect SIM Episode Payments/Withholds by Year End
  • OHA Issues Call for 2018 Annual Meeting Presentations

August 2017

>>> Download the August Edition

  • OHA Summary Recaps State Budget Provision, Ohio Senate Overrides Health Care-Related Vetoes
  • 2018 Payment, Policy Updates for Medicare Admissions Finalized
  • OHA Comments on Proposed Medicaid DSH Reductions
  • CMS Cancels Episode, Cardiac Bundle Payment Models; Proposes Changes to Joint Replacement Model
  • OHA Provides Impact Analysis, CMS Comments Due by Sept. 11 on OPPS Proposed Rule for CY 2018
  • 2018 Meaningful Use Data Submission Updated
  • Medicare Recovery Audit Program Update Issued on Recalled ADRs
  • 2017 Quality Payment Hardship Exception Application Live
  • OHA Submits Comments on BWC Proposed State-Fund Payment System
  • OHA Advocates Holding Hospital Rates, ODM to Track Medicaid Spending
  • Traditional Ohio Medicaid Observation Services Codes Under EAPGs
  • Managed Care Plans Announce EAPG Implementation Delay Resolution
  • Ohio Hospitals Inquire on CareSource Claims, Policy, Communication Initiatives that Continue to Pend Unresolved
  • KEPRO Begins ODM Program Integrity Auditing
  • OHA Protests Anthem Plan to Audit for Medical Necessity on High-Tech Imaging in ED
  • Opiate Prescribing Limits
  • Transparency Lawsuit
  • Tax Exemption Revoked
  • Hold the Dates
  • Just the Facts

July 2017

>>> Download the July Edition

  • CY 2018 Medicare OPPS Proposed Rule is Out
  • CMS Directs Hospitals to Revise FFY 2015 S-10 Form by Sept. 30
  • 3 Changes Hospitals May Need to Make for New Medicare Cards with New Numbers
  • AHA Issues Bulletin on CMS Proposed Rule for Medicaid DSH Reductions
  • Ohio’s Price Transparency Law – Update
  • Ohio Medicaid’s Inpatient Hospital Reimbursement Rule Updated to Reflect Cuts from Governor’s Budget
  • ODM to Send 2017 HCAP Assessment Letters July 21
  • Important Medicaid EHR Incentive Program Information Released
  • ODM Remains on Target for Aug. 1 EAPG Implementation
  • ODM Reminds Hospitals How to Bill Observation Services on Aug. 1
  • ODM Announces 340B Modifier Implementation Date for Hospital 340B Entities
  • NDC Claim Enforcement Takes Effect Jan. 1, 2018
  • OHA Continues to Discuss Claims, Policy, Communication Issues with CareSource
  • Hospitals Report Success in Using ODMs Medicaid Provider Complaint Spreadsheet Process
  • Ohio Hospitals Bill New Outpatient Behavioral Health Service Codes Aug. 1 
  • ODM Sets Timeline for Behavioral Health Redesign Implementation
  • ODM Announces Specialized Recovery Services Program Updates
  • Ohio BWC Proposed State-Fund Hospital Payment Plan for CY 2018
  • Hold the Dates
  • Just the Facts

June 2017

>>> Download the June Edition

  • State Budget Bill Heads to Governor’s Desk
  • OHA Submits Comments on Proposed FY 2018 Hospital IPPS
  • CMS Announces Medicare Beneficiary Identifier Look-Up Tool
  • BWC Budget Finalized by General Assembly, Headed to Governor
  • Ohio’s Price Transparency Law - Update
  • HCAP Annual Meeting Materials Published
  • ODM Announces New Target Date for the Medicaid EAPG Implementation
  • ODM Announces New Utilization Review Contractor
  • OHA Updates Medicaid Provider Complaint Spreadsheet Process
  • ODM Changes List of Covered Codes for Hospitals and/or ASC’s
  • SIM Providers to Receive Episode Reports Linked to Payment
  • Ohio Hospitals Inquire on CareSource Claims, Policy, Communication Initiatives
  • ODM Announces July 6 Effective Date for New OAC Rules
  • Hold the Dates
  • Just the Facts

May 2017

>>> Download the May Edition

  • Hospitals’ Advocacy Efforts Continue as Budget Bill Moves to Senate
  • 2017 UPL Payments Revised for 4th Quarter
  • Final 30-Day Window Opens for Changes to SFY 2016 Cost Reports
  • NDC Claim Enforcement Takes Effect Jan. 1, 2018
  • 3M CGS EAPG Desktop Grouper Settings Released
  • ODM, Managed Care Plans 835 Remit to Return EAPG Information to Hospitals
  • 3M Offers OHA Hospitals Group Discount on EAPG Software
  • New Rules Anticipated for 340B Entities Billing 340B Drugs
  • Outpatient Hospital Behavioral Health Services Website Updated
  • OHA Launches Medicaid Provider Complaint Spreadsheet
  • Mandatory Comprehensive Care for Joint Replacement Model Delayed Until Jan. 1, 2018
  • State Innovation Waiver Checklist Issued
  • Performant Recovery: Region 1, Region 5 Update
  • Hold the Dates
  • Just the Facts

April 2017

>>> Download the April Edition

  • House Amends Hospital Budget Provisions, Adds Medicaid Work Requirements
  • ODH Issues Final Guidance on Schedule H Reporting
  • ODM Delays Behavioral Health Redesign
  • 2011 DSH Audit Recoupment Underway
  • 340B Requirements Shifting
  • Medicare FFY 2018 Inpatient PPS, LTCH PPS, Inpatient Psychiatric Proposed Rules Released
  • CMS Social Security Number Removal Initiative Dates Set
  • CareSource Updates OHA Member Groups on Claim Reprocessing, Credentialing Delays, System Enhancements
  • Hold the Dates
  • Just the Facts

March 2017

>>> Download the March Edition

  • Hospital Executives Testify to HHS Finance Subcommittee Against State Budget Cuts, Non-Contracting Language
  • Final Hospital Base Rates, EAPG Relative Weights, APRDRG Weights Released for July 1
  • SFY 2016 Cost Report Review Complete
  • Requirements for 340B Covered Entities Delayed
  • MOON FAQs Posted Online
  • Identifiers to Replace Social Security Numbers
  • CareSource Commits to Improved Claims Editing, Provider Credentialing
  • AHA Meeting Provides Next Opportunity for ACA Discussion
  • First Round of ADRs Distributed
  • New VA Resources Available
  • Hold the Dates
  • Just the Facts

February 2017

>>> Download the February Edition

  • Budget Focuses Resources on Pay for Value, Population Health
  • HHS Updates Poverty Guidelines
  • Court Delays Hearing on Price Transparency Suit
  • CMS MOON Requirements Effective Next Week
  • Hospitals Report Continued Struggles with CareSource Payment, Edit Policies
  • Medicare Audit Contractor Meeting with Hospitals
  • State Releases Final SHIP, Guidance
  • Hold the Dates
  • Just the Facts

January 2017

>>> Download the January Edition

  • CMS Finalizes Home Health Rules, Beneficiary Protections 
  • Hearing Date Extended in Price Transparency Lawsuit
  • CMS Posts Final Hospital MOON Form Instructions
  • CareSource Increasing Outreach OB Payment, Clinical Edit Policies 
  • CMS Releases Guidance on Site-Neutral Payment Policy 
  • State Shares 2017 Expectations for SIM
  • OHA Releases 2016 HCAP Model, ODM Mails Assessment Letters 
  • Hold the Dates
  • Just the Facts



December 2016

>>> Download the December Edition

  • Judge Halts Start Date for Ohio Price Transparency Law 
  • OHA Board Endorses Medicaid Hospital Payment Modernization Model
  • CMS Posts Final Hospital Observation Notice for Implementation by March 6
  • CMS Provides More Detail on New Medicare RAC Contracts 
  • ODM To Move More Ohioans to Managed Care in January
  • ODM to Introduce New Provider Requirements for 340B Drug Pricing Program
  • CMS Finalizes Bundled Medicare Payment Models for Cardiac, Hip Fracture Care
  • CMS Announces Additional Opportunities for Clinicians Under the Quality Payment Program
  • OHA Accepting Nominations for Health Care Worker of the Year, Leadership Awards
  • Hold the Dates
  • Just the Facts

November 2016

>>> Download the November Edition

  • OHA Mourns the Loss of Long-time Associate Berna Bell
  • CMS Final Outpatient Payment Rule Includes Revised Site-Neutral Policy
  • ODM Finalizes SFY 2017 UPL Payments
  • CMS Awards New Medicare RAC Contracts, Releases Details on Reopened Hospital Appeals Settlement
  • CMS Releases Final 2017 Physician Payment Rule
  • CMS Releases Home Health Final Rule for CY 2017
  • CMS Announces Medicare Premiums, Deductibles for CY 2017
  • CMS to Remove Social Security Numbers from the Medicare System
  • Hold the Dates
  • Just the Facts

October 2016

>>> Download the October Edition

  • OHA, Anthem Review New Payment Policies
  • Updated SFY 2017 UPL Payment Data Now Available
  • OHA Publishes 1st Post-Expansion Community Benefit Report
  • AHA: 'Get Ready for MACRA'
  • New BWC Claims, Policy System Coming in November
  • Exchange Open Enrollment Starts Nov. 1
  • Still No News on New Medicare RAC Contracts; as AHA Asks Court to Order HHS to Implement 3 Appeals Backlog Solutions
  • Health Affairs Study: Most Readmissions After 7 DaysMay Be Beyond Hospitals' Control
  • Still Waiting on the Final Medicare Observation Notice
  • Hold the Dates
  • Just the Facts

September 2016

>>> Download the September Edition

  • Preliminary Hospital-Specific HFF/UPL Update Posted
  • OHA Opposes CMS Plan to Abruptly Change Payment, Billing for Provider-Based Entities
  • ODM Proposes Penalty Program for Excess Readmissions
  • CMS Denies Healthy Ohio Program Waiver
  • Medicare Groups Resume Two-Midnight Reviews
  • Anthem Defends Plan to Install Site-Neutral Provisions
  • Reminder: 2018 Essential Community Provider Applications Due Oct. 15
  • CBO: 'If Hospitals Don't Improve Productivity, 60 Percent Will Lose Money by 2025'
  • New Options for ODM-Permedion Claims Resubmission
  • Ohio MITS EDI Transition
  • 2017 OHA Annual Meeting Call for Presentations
  • Just the Facts

August 2016

>>> Download the August Edition

  • Ohio Medicaid Delays Payment Rabsing Until July 2017
  • Medicaid Will Require Drug Codes on Outpatient Hospital Bills
  • AHA Urges CMS to Delay Medicare Site-Neutral Proposal Due to Fraud and Abuse Risks
  • Ohio Medicaid Permedion Recoupment Rebill Denials
  • Medicare Inpatient Acute and Long Term Care Hospital Final Rules for 2017 Are Out
  • OHA Protests Anthem Plan to Install Site-Neutral Provisions via Manual
  • ICYMI: Replay Available for OHA Medicare Quality-Based Payment Reform Programs Webinar
  • State Innovation Model Episodes of Care Demonstration Moving Forward
  • 2016 State Health Assessment Available, Work Begins on Imporvement Plan
  • ODM Releases 2106 Managed Care Plans Report Card
  • Ohio Opts for CPC+ Program
  • Ohio Hospitals Reporting Eligibility Shifts with Medicaid Redesign
  • OHA Comments on Ohio BWC 2017 Proposed State-Fund IPPS
  • Hold the Dates

July 2016

>>> Download the July Edition

  • CY 2017 Medicare OPPS Rule Comments Due Sept. 6
  • Ohio BWC Proposed Payment Plan Models CMS'
  • CMS Proposes New Medicare Bundled Payment Models for Cardiac, Hip Fracture Care
  • HHS Proposes Changes to Medicare Appeals Procedures
  • Medicare's Payment Reform Could be Delayed
  • Ohio Medicaid End SFY 2016 $1.3B Under Budget
  • Ohio Medicaid Eligibility Redesign
  • Just the Facts
  • Hold the Dates

June 2016

>>> Download the June Edition

  • HCAP Meeting Materials Available
  • New Hospital Insights Details CMS Updates to Medicaid, CHIP Managed Care Regulations
  • CMS Delays New Medicare Claims Coding, Documentation Policy for Unused Drugs
  • OHA Still Negotiation with ODM on Medicaid EAPG OPPS, Rebased IPPS
  • Ohio Prior Authorization Bill Signed Into Law
  • Possible Delay of Medicare Outpatient Observation Notice
  • Sign Up for Updates on Medicaid Managed Care Behavioral Health Carve-In
  • CMS Issues Details on Pause of Medicare QIO Two-Midnight Reviews
  • CMS Issues Final Rule on Medicare Payments for Laboratory Tests
  • Just the Facts
  • Hold the Dates

May 2016

>>> Download the May Edition

  • CMS Pauses Quality Improvement Two-Midnight Reviews
  • Tiberi Introduces Bill to Help Hospitals, Improve Patient Care
  • Medicare Outpatient Observation Notice Will Require Close Coordination
  • 2015 HCAP Assessment and Payment Schedule
  • OHA Finance Committee to Debate Latest EAPG OPPS and Rebased IPPS Impact Models at June 9 Meeting
  • SFY 2016 Ohio Medicaid Cost Report Software Available
  • Just the Facts
  • Hold the Dates

April 2016

>>> Download the April Edition

  • CMS Releases Multiple Proposed Payment System Rules
  • OHA Whitepaper on Proposed Medicaid Waiver Available
  • BWC Updates Outpatient Hospital, ASC Fee Schedules
  • OHA Finance Committee Considering Medicaid EAPG OPPS and Rebased IPPS Impact Models; 3M Extends Discounted EAPG
  • Final 30-Day Window for SFY 2015 Cost Report Corrections Starts April 30
  • West Virginia Medicaid Out of Money?!
  • CMS Issues Final Rule for Medicaid, CHIP Managed Care Plans
  • ODM/DataGen Medicare Comprehensive Care for Joint Replacement Demo Webinar Available
  • Just the Facts
  • Hold the Dates

March 2016

>>> Download the March Edition

  • Ohio Medicaid Delays Start of New Payment Plans, Peer Groups
  • 3M Offers Ohio Hospitals Group Discount on EAPG Software
  • SFY 2015 Medicaid Cost Reports Need Immediate Review
  • 2015 HCAP/Hospital Franchise Fee Timelines Set
  • Community Benefit 2016 Survey Deadline April 8
  • OHA Distributes Uncompensated Care, Medicare Spending Analyses
  • VA Revises Veterans Choice Contract to Speed Payment to Providers; OHA Meeting with Ohio VA Reps on Claims Processing
  • Medicare Part B Drug Payment Comments Due May 9
  • CMS Finalizes Medicaid, CHIP Mental Health Parity Rule
  • AHA Survey Shows 6 of 10 Medicare RAC Claims Were Not Overpaid
  • Archive Copy of March 8 ODM/HMSPermedion Webinar Available
  • Just the Facts
  • Hold the Dates

February 2016

>>> Download the February Edition

  • Negotiations continue on Medicaid Hospital Peer Groups
  • Don't Miss OHA's Price Transparency Webinar on March 30
  • 2016 OHA Community Benefit Survey to go Out in March
  • Hospitals Have Six Months to Prepare for the Notice of Observation Treatment and Implication for Care Eligibility Act
  • CareSource to Meet with OHA Committee March 16 to Review Billing Issues
  • Non-Specific ICD 10 Codes are Problematic for OHio BWC
  • Updated Medicaid PPR Reports to be Posted March 4
  • CMS Issues Final Rule for Reporting, Repaying Medicare Overpayments
  • 2014 OHA HIC Financial Performance Report Available
  • AHA Annual Survey Deadline March 31
  • New Health Economics and Policy Director Joins OHA
  • Just the Facts
  • Hold the Dates

January 2016

>>> Download the January Edition

  • OHA to Launch Webinar Series with Medicare RAC Update
  • 2015 HCAP Delayed by Rulemaking Process
  • Franchise Fee, UPL Rule Pending Approval
  • ODM Updating Hospitals' HCAP/Cost Report Contacts
  • Ohio Medicaid Increases Payment Rates for Primary Care Physician Services
  • 2016 Federal Poverty Income Guidelines Released
  • OHT Issues Population Health Report that Could Affect Hospitals' Community Health Planning
  • Ohio BWC Finalizes 2016 Inpatient Hospital Payment Rule
  • MedPAC Recommends 2017 Medicare Payment Rates for Hospital Services
  • CMS Releases FAQx on Use of PO Modifier
  • AHA Examines Medicare Bundled Payment Initiatives

December 2015

>>> Download the December Edition

  • Alderson, Lauricia to Head 2016 OHA Finance, ABC Committees
  • ODM Proposes New Medicaid PPS Hospital Peer Groups; Updates Outpatient Hospital Fee Schedules
  • OHA Health Insuring Corporation Annual Report Due in January
  • Episodes-of-Care Demonstration Progressing
  • Medicare Final Rule on DMEPOS Prior Auth Released
  • Bricker & Eckler Reminds Hospitals About Medicare Modifier, POS Code for Off-Campus Provider-Based Departments 
  • Medicare Physician reimbursement policy and fee schedule alerts
  • CMS Previews 2017 Medicare Advantage Capitation Rate
  • IRS: Hospitals Can Report Housing on Part I of 2015 Schedule H
  • Just the Facts
  • Hold the Dates

November 2015

>>> Download the November Edition

  • CMS Finalizes 2016 Medicare Final Rules, Including Outpatient PPS and ASC Policy
  • No Major Issues with ICD.10 Conversion (so far); CMS Clarifies Actions to Address Isolated Issues with NCDs
  • OHA Recommends Phased-In Changes to Medicaid GME Payment Formula
  • Final Rule Released on Medicare Joint Replacement Bundled Payment Demo
  • CMS Announces Medicare RAC Program Improvements
  • Ohio Medicaid to Suspend Inpatient Hospital Pre-certifications until 2017
  • BWC Releases Plans to Update Outpatient Hospital Payments in 2016
  • Medicare 2016 Premiums, Deductible and Co-Insurance Amounts Released
  • OHA 2016-2018 Strategic Plan Upholds Mission-Critical Initiatives
  • Call for Nominations - 2016 Health Care Worker of the Year, Leadership Awards
  • Hospital Advocates Pursue Medicare Outpatient Department Amendment
  • Just the Facts

October 2015

>>> Download the October Edition

  • Update on Episodic Payment Reform, Patient-Centered Medical Homes
  • Federal Bipartisan Budget Act of 2015
  • HCAP/Hosptial Franchise Fee Programs Include a Third 2014 HCAP Payment
  • OHA Comments on HRSA 340B Drug Discount Program "Mega Guidance"
  • Medicaid to Update Hospital Outpatient Coverage, Payment Rule and Hospital Billing Guidelines
  • Medicare Diagnostic Laboratory Payments Proposed Rule
  • Just the Facts
  • Hold the Dates

September 2015

>>> Download the September Edition

  • ICD-10 Conversion to be Monitored
  • Medicaid EAPG Outpatient Payment System Delayed
  • Federal Court Rules CMS Unlawfully Imposed Two-Midnight Cut
  • Ohio Medicaid To Adopt Outpatient NCCI Edits
  • CGS Warns New Release Will Cause "Dark" Days for System
  • OHA Medicaid DSH Program Audit Webinar, Materials Available
  • Uninsured Rate Dropped to 10.4% in 2014
  • AHA Regulatory Advisory on 340B Mega Guidance
  • Franchise Fee, UPL Update

August 2015

>>> Download the August Edition

  • All’s Quiet on the ICD.10 Front (so far)
  • OHA Recommends Two-Year 2016/2017 HCAP Model
  • Second 2014 HCAP Payment Released
  • Updated 2015 Preliminary HCAP Model
  • FFY 2012 Medicaid DSH Audit Results Out
  • Urge Your Representative to Cosign Letter Urging CMS to Provide a Positive Outpatient Update
  • CMS Again Delays Two-Midnight Rule Enforcement, Moves Short Stay Reviews to QIOs
  • Medicare Comprehensive Care for Joint Replacement Model
  • OHA Board Commends Task Force on Health Transformation, Charts New Course for Sustainability Strategy
  • Just the Facts
  • Hold the Dates

July 2015

>>> Download the July Edition

  • OHA Overview of CY 2016 Medicare OPPS Proposed Rule Available
  • OHA Comments to CMS Proposed Rule on Medicaid and the Children’s Health Insurance Programs
  • CareSource Compromises on NCCI Code-Pair Medical Reviews
  • New Ohio Medicaid Hospital OPPS Moving Forward
  • 2016/2017 State Budget Summary
  • CMS Withdraws Request for Quotes for Medicare RAC Contracts
  • Pre-Admission Review and Residency Review (PASRR) Contractor Change
  • IRS Clarifies Provider List Rule for Hospital Financial Assistance Policies
  • CMS Launches ‘Dry Run’ Test of Overall Hospital Quality Star Ratings
  • 2015 Preliminary HCAP Update
  • Just the Facts
  • Hold the Dates

June 2015

>>>  Download the June edition

  • Updated Ohio HCAP and Free Care Guidance
  • Medicaid Eligibility Redeterminations Legal Settlement
  • MACPAC and MedPAC Annual Reports are Out
  • OHA Recommending UB-04 Revenue Code 0929 for SAFE Charges on Hospitals’ Bills
  • 2016 UB-04 Manual Available for Order
  • CMS Releases ACO Final Rule
  • July 2015 Medicare Claims Software Release Will Cause Several "Dark" Days for the Common Working File (CWF) Hosts
  • Medicare MAC Satisfaction Survey
  • Still no Word on Ohio Medicare or Medicaid RAC Contracts
  • OHA Unveils the Institute for Health Innovation
  • AHA Testifies at Hearing on VA’s Ability to Promptly Pay non-VA Providers
  • Just the Facts
  • Hold the Dates

May 2015

>>> Download the May edition

  • State Budget Moves to the Ohio Senate
  • Ohio Medicaid Releases Anticipated 2014 HCAP Schedule
  •  2015 Medicaid Cost Report Software Posted
  • OHA Posts Hospital-Specific Analyses of 2016 Medicare IPPS Proposed Rule
  • Preliminary 2013 Medicaid DSH Program Audit Results Out
  • CMS Issues Proposed Rule for Medicaid and CHIP Managed Care Plans
  • CMS Also Proposes Mental Health Parity and Addiction Equity Rule
  • AHA Urges Congress to Enact RAC Reforms
  • …And Testifies at Senate Hearing on Hospital Observation Stays
  • ODM Offering Medicaid ICD.10 Webinar, Adds ICD.10 Q&A Documents
  • AHA Smartmarket
  • 2012 IRS 990 Schedule H Data Demonstrates Hospitals’ Community Benefit
  • CGS to Target Spinal Injections for Medical Review
  • Just the Facts
  • Hold the Dates

April 2015

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  • ‘Tis the Season for Medicare PPS Payment Rules
  • Ohio Biennial Budget Clears House of Representatives
  • BWC Updates Outpatient Hospital and ASC Fee Schedules for 2015
  • ODM Sends 2015 Franchise Fee Notices to Hospitals
  • OHA Supports ODM Public Rules on 2014 HCAP
  • OHA Economic Impact Report
  • CMS Releases First Ever Hospital Compare Star Ratings
  • 2015 Medicare and CHIP Reauthorization Act 
  • Billing for Inpatient Hospital LARC Services in Conjunction with a Delivery
  • Partial Delay of Medicare “Two-Midnight” Policy Extended Through Sept. 30
  • Medicaid ICD.10 Updates
  • Episode Based Payments Wave II Planning Begins
  • Just the Facts
  • Hold the Dates

March 2015

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  • ODM Releases Revised Collection & Payment Schedule for 2015 Hospital Franchise Fee and Upper Payment Limit (UPL) Payments
  • Ohio Medicaid Moving Forward on 2016 OPPS Design
  • CMS Drops Seven Medicare National Coverage Determinations
  • Medicaid Computer Upgrade Accidentally Terminates Some Providers’ Enrollment
  • Medicaid Non-Institutional Provider Fee Schedule Updated
  • CMS OPPS Transmittal Adds Instructions on Hospital Billing for Inpatient-Only Procedures and Provider-Based Services
  • OIG Recommends Medicare pay SNF rates for CAH swing beds and Reduce Hospital Payments for Routine Outpatient Surgical Procedures
  • Significant Reforms of the Medicaid Behavioral Health Benefit Proposed
  • Volunteer for July Medicare ICD-10 End-to-End Testing; Forms Due 4/17
  • Reminder to Submit AHA Annual Hospital Survey
  • Just the Facts
  • Hold the Dates

February 2015

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  • State Budget Proposals Include Increase in Hospital Franchise Fee
  • Medicaid Reenrollment Project Threatens Expansion Success
  • Episode-Based Payments Data will be Posted in Early March
  • Lobbying Expenditures
  • Benchmark Medicaid Potentially Preventable Readmissions Data Posted
  • Economic Impact of Ohio Hospitals
  • Medicare RACs Approved to Begin Manual Therapy Cap Medical Reviews
  • Essential Community Providers
  • Ohio Bureau of Workers Compensation
  • ICD-10 Testing with Ohio Department of Medicaid
  • AHA Urges CMS to Address Hospital Short Stays in FY 2016 IPPS Rule
  • AHA Annual Survey
  • ABC Meets with CareSource on Claims Processing and Provider Outreach
  • Hold the Dates

January 2015

>>> Download the January edition

  • Draft 2015 Hospital Franchise Fee Schedule Posted
  • …As is Draft 2015 Hospital UPL Payment Schedule
  • IRS/Treasury Final Rule Requirements for Charitable Hospitals
  • Medicaid Potentially Preventable Readmissions Project Underway
  • ODM Also Planning New Medicaid OPPS for January 2016
  • 2015 Federal Poverty Income Guidelines Released
  • CGS Outlines Medicare Audit Contacts for 2015
  • ODM to Edit for Attending Physician Enrollment on Medicaid Bills
  • AHA Issues Case Study Report on Hospital Discharge Planning Tools
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