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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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OHA Admitting, Billing and Collection Committee Spotlight

01/31/2019

The OHA Admitting, Billing & Collection Committee met Jan. 16, and the following topics were covered: Ohio’s Medicare Administrative Contractor, CGS, updated the committee members on systematic validation edits for OPPS providers with multiple service locations and DDE enhancements.OHA staff updated the committee members Read More . . .

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

01/31/2019

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 . . .

IRS Releases New Guidance for Tax-exempt Employers on Parking Tax

01/31/2019

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 the provision Read More . . .

Ohio Medicaid Publishes 2019 Hospital Rates

01/31/2019

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 . . .

Third HCAP Distribution Coming Jan. 28

01/31/2019

At the time of the second 2018 HCAP distribution there were two hospitals with outstanding assessments, resulting in a decreased second distribution for all hospitals. As a consequence of one of those assessments being paid, there will be a third distribution for 2018 HCAP on Jan. 28. The hospital-specific distributions can be found Read More . . .

Ohio Medicaid Updates Operational Issues to Hospitals at the Large Provider Group

01/31/2019

The Ohio Department of Medicaid on Jan. 18 provided its quarterly update to Ohio hospitals regarding operational issues. ODM’s key updates included:EAPG Issues and FixesFor Observation adjustments where the second day of observation was packaging for $0.00 payment or discounting 50 percent payment from July 1, 2018 – Nov Read More . . .

Ohio Medicaid Publishes General Policy Updates

01/31/2019

The Ohio Department of Medicaid on Jan. 18 provided a quarterly general policy update to Ohio hospitals. ODM’s key policy updates included:Annual HCPCS/CPT Code UpdatesODM is working on their system update to include all new covered HCPCS and CPT Codes for 2019 and will have the codes built into its grouper by Feb. 14.Addition Read More . . .

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

01/31/2019

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 . . .

ODM Addresses Expired Sterilization Consent Form

01/31/2019

The Ohio Department of Medicaid fee-for-service policy staff members recently reviewed the Ohio Medicaid consent-for-sterilization form posted on the department's website and confirm that they have extended the expiration of the current form to Jan. 31 with no other changes to the form. The extension will enable ODM to awai Read More . . .

CMS Suspends Medicaid DSH Policy During Appeal

01/31/2019

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 . . .

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

01/31/2019

CMS 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 certain billing staff are aware of these instructions. & Read More . . .

Medicare Fee-for-Service Enhancements Make It Easier for Hospitals to Look-Up Claims

01/31/2019

The January 2019 quarterly system release, which was implemented on Jan.7, includes changes to the following FISS DDE screens.  In addition, the following chapters of the Part A DDE User Manual/Reference Guide and the home health and hospice FISS DDE Guide have been updated to reflect these changes.   The new selecti Read More . . .

New 2019 Medicare QPP Resources Available

01/31/2019

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 . . .

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

01/31/2019

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 . . .

Exchange Plan Enrollment Down Slightly

01/31/2019

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 . . .

Ohio BWC Offers Free Educational Webinars to Providers

01/31/2019

BWC invites hospital staff members to participate in the following educational webinars that support providers in their treatment of Ohio’s Injured workers. Join BWC’s medical policy unit for webinars on topics about billing and reimbursement policy, coverage and service provision. Registration is required for each live Read More . . .

HCAP Model Updated

11/30/2018

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 . . .

OIG Identifies Vulnerabilities in Hospital Wage Index

11/30/2018

The U.S. Department of Health and Human Services’ Office of Inspector General on Nov. 27 released a report identifying vulnerabilities in the hospital wage index system that impact Medicare payments to providers. The report goes on to state ways in which the current data used to calculate wage indexes is not always an accurat Read More . . .

ODM Changes Utilization Review Vendor

11/30/2018

The Ohio Department of Medicaid has announced a new hospital utilization review vendor. Effective Dec. 1, HMS Permedion will assume responsibility for processing: Home health prior authorizationsBehavioral health prior authorizations for Medicaid fee-for service consumers not participating in a managed care planHospital medical-s Read More . . .

Ohio Medicaid Proposes Restricted Medicaid Coverage Rule

11/30/2018

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 . . .

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