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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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CY 2018 Medicare OPPS Proposed Rule is Out

07/31/2017

The proposed calendar year 2018 payment rule for the Medicare Outpatient Prospective Payment System was published in the July 20 Federal Register. The proposed rule includes annual updates to the Medicare fee-for-service outpatient payment rates as well as proposed regulations that implement new policies, among other regular up Read More . . .

CMS Directs Hospitals to Revise FFY 2015 S-10 Form by Sept. 30

07/31/2017

CMS Transmittal 1863, Change Request 10026 released on June 30, provides updated data for determining the disproportionate share adjustment for IPPS hospitals and the low-income patient adjustment for inpatient rehabilitation facilities s as well as payments as applicable for long term care hospital discharges. The transmittal goes Read More . . .

3 Changes Hospitals May Need to Make for New Medicare Cards with New Numbers

07/31/2017

The Medicare Access and CHIP Reauthorization Act of 2015 requires CMS to remove Social Security numbers from all Medicare cards by April 2019. CMS will begin mailing new Medicare cards with a new Medicare number (currently called the Medicare Claim Number on cards) to your patients in April 2018. Hospitals may need to change systems Read More . . .

AHA Issues Bulletin on CMS Proposed Rule for Medicaid DSH Reductions

07/31/2017

The Centers for Medicare & Medicaid services today published a proposed rule in the federal register that describes the methodology the agency plans to use to implement the Medicaid DSH cuts first authorized by the Affordable Care Act. The American Hospital Association Special Bulletin can be found here. The DSH cuts were origi Read More . . .

Ohio’s Price Transparency Law – Update

07/31/2017

Despite OHA’s best efforts to resolve the price transparency issue during the state budget process, the existing price transparency law that is the subject of OHA’s lawsuit remains in place. The court order preventing the law from going into effect still stands. OHA is preparing for a hearing currently scheduled for Read More . . .

Ohio Medicaid’s Inpatient Hospital Reimbursement Rule Updated to Reflect Cuts from Governor’s Budget

07/31/2017

The Ohio Department of Medicaid filed its revised inpatient hospital reimbursement rule 5160-2-65 on June 26, and it became effective July 6. The inpatient hospital rule includes a revision to cut hospitals 3.7 percent on all inpatient relative weights for what ODM claims is a result of excessive case-mix caused by the implementatio Read More . . .

ODM to Send 2017 HCAP Assessment Letters July 21

07/31/2017

ODM will send out assessment letters relation to 2017 HCAP on Friday, July 21. The letter will contain your hospital’s total assessment to be paid in accordance with the 2017 HCAP model. A generic letter can be found here.   The assessment will be paid by hospitals in two equal installments, due Aug. 11 and Aug. 29. Pay Read More . . .

Important Medicaid EHR Incentive Program Information Released

07/31/2017

The U.S. Department of Health and Human Services Office of Inspector General in August 2016 issued an audit report finding that Ohio’s Medicaid Provider Incentive Program, or MPIP, made incorrect Medicaid electronic health record incentive payments to hospitals totaling $526,000, based on its review of a sample size Read More . . .

ODM Remains on Target for Aug. 1 EAPG Implementation

07/31/2017

The Ohio Department of Medicaid reports it remains on target with the Aug. 1 implementation date for the new 3M EAPG grouper. ODM also reports Ohio's Medicaid managed care plans, CareSource, Molina, UHC, Buckeye and Paramount, are prepared to go-live with the EAPG grouper on Aug. 1 as well. Hospitals are encouraged to report an Read More . . .

ODM Reminds Hospitals How to Bill Observation Services on Aug. 1

07/31/2017

The Ohio Department of Medicaid's policy team on July 24 released a reminder to Ohio hospitals that G0378 is the preferred method of reporting observation services when Medicaid updates its OPPS to EAPGs on Aug. 1. It is ODM's policy to also pay observation services when reported with the 992XX CPT codes, however, ODM recom Read More . . .

ODM Announces 340B Modifier Implementation Date for Hospital 340B Entities

07/31/2017

The Ohio Department of Medicaid’s policy team announced on July 27 that all 340B entities that bill on a hospital outpatient UB04 will be required to bill an SE modifier on all 340B drug lines provided in an outpatient setting beginning Oct. 1. OHA announced to the membership on May 9 that the requirement would be forthc Read More . . .

NDC Claim Enforcement Takes Effect Jan. 1, 2018

07/31/2017

The Ohio Department of Medicaid announced its required National Drug Codes for all pharmacy line items on outpatient hospital Medicaid bills with an enforcement date of Jan. 1, 2018. ODM approved the new process in August 2016 with an effective date of Jan. 1, 2017, but then delayed the enforcement date until Jan. 1, 2018 Read More . . .

OHA Continues to Discuss Claims, Policy, Communication Issues with CareSource

07/31/2017

OHA held a conference call with CareSource Vice President of Ohio Market Operations Dan Hounchell on July 24 to follow up on CareSource’s progress in addressing claims processing issues, policy development and communication breakdowns with hospital providers throughout Ohio. On the call, CareSource provided OHA with updates to Read More . . .

Hospitals Report Success in Using ODMs Medicaid Provider Complaint Spreadsheet Process

07/31/2017

Hospitals reported to OHA in July that the new process is yielding positive results in resolving claim and payment issues with the Medicaid managed care plans! OHA  worked with the Ohio Department of Medicaid’s Bureau of Managed Health Care to develop a user friendly provider complaint form spreadsheet. The Provider Comp Read More . . .

Ohio Hospitals Bill New Outpatient Behavioral Health Service Codes Aug. 1 

07/31/2017

Beginning Aug. 1 with implementation of Ohio Administrative Code rule 5160-2-75, hospitals that have secure accreditation (such as JCAHO) to provide outpatient behavioral health services to Medicaid-eligible individuals can bill to newly developed Outpatient Behavioral Health Services codes. ODM informed OHA on July 24 th Read More . . .

ODM Sets Timeline for Behavioral Health Redesign Implementation

07/31/2017

Ohio’s Behavioral Health Redesign did not go into effect on July 1, in deference to the legislative budget process. The Ohio Department of Medicaid and the Ohio Department of Mental Health and Addiction Services are providing the following updated information for behavioral health redesign implementation resulting from the fin Read More . . .

ODM Announces Specialized Recovery Services Program Updates

07/31/2017

The Ohio Department of Medicaid is amending the approved Specialized Recovery Services Program, operated under the authority of the 1915i State Plan, to include additional individuals who have been diagnosed with chronic conditions or who are active on the solid organ or soft tissues transplant waiting list. This includes individual Read More . . .

Ohio BWC Proposed State-Fund Hospital Payment Plan for CY 2018

07/31/2017

The Ohio Bureau of Workers Compensation this month met with OHA to discuss its proposed 2018 updates to its inpatient hospital prospective payment system, or IPPS. Modeled on CMS’ Medicare IPPS, the BWC version uses most of the same MS-DRG grouper and pricer components, but adjusts each resulting Medicare payment by a BWC Read More . . .

Just the Facts - July 2017

07/31/2017

The Ohio Department of Medicaid reported it recently uncovered the newly posted relative weights for psychiatric DRGs were incorrect on the department’s website. Psychiatric DRG relative weights were supposed to be held constant at the weights which were in effect on Jan. 1, in accordance with newly revised OAC rule 5160-2-65. Read More . . .

Hold the Dates - July 2017

07/31/2017

Medicare & Medicaid in 2017 (aka the annual OHA “Larry & Larry Show”) has been scheduled for Thursday, Sept. 14. The meeting agenda and registration information are now available on OHA’s Education Website located here. Read More . . .

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