By the Numbers
A monthly compendium of OHA finance and patient financial services policy and payment alerts
05/31/2018
The results for the 2015 Federal Disproportionate Share Hospital Audit conducted by Myers & Stauffer for the Ohio Department of Medicaid began being released May 14.
Hospitals that Myers & Stauffer determined to be in a recoupment status will be released first. Hospitals in recoupment status have 10 days to contact Myers &a
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05/31/2018
CMS Administrator Seema Verma on May 7 offered hospital executives good and bad news on Medicaid coverage limits and accountable care organizations' risk contracts during her presentation to the American Hospital Association annual meeting. CMS will reject Kansas' request to impose lifetime limits on Medicaid coverage,
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05/31/2018
The Ohio Hospital Association, through the Admitting, Billing & Collection Committee, last month was able to get new language added to future Ohio Department of Medicaid Managed Care Plan Provider Agreements. The new language: “The MCP is required to give a 30-calendar day advanced notice to providers of any new edits
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05/31/2018
CareSource leadership on May 14 provided updates on a comprehensive list of outstanding issues OHA has been working for more than a year to resolve on behalf of member hospitals with Ohio’s largest Medicaid managed care payer. The core issues include claim processing breakdowns, covered service discrepancies, inappropriate den
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05/31/2018
Barbara Sears, director, Ohio Department of Medicaid, on May 7 discussed the status of Behavioral Health Redesign with the Joint Medicaid Oversight Committee. You can view her presentation here.
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05/31/2018
The Ohio Department of Medicaid reports that some Medicaid secondary claims experienced processing issue during the month of April. The processing issue providers may see is that the Medicare paid amount is zero and the payment went to the deductible instead of paying Med Max. ODM advised that providers may adjust their claims, howe
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05/31/2018
The Ohio Department of Medicaid’s program integrity quality contractor, KEPRO, launched its first quarterly Ohio newsletter this week. The first KEPRO Connect Ohio newsletter focuses on substance use disorder prior authorization tips, hospital retrospective review recommendations and how to appeal a retrospective review denial
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05/31/2018
Anthem Blue Cross Blue Shield announced its new policy for Ohio, Indiana, Kentucky and Missouri that will become effective Aug. 1. The policy details the health plan’s guidelines for claims requiring additional documentation and the facility’s compliance for the provision of requested documentation.
In addition to the r
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05/31/2018
The Centers for Medicare & Medicaid Services released its FFY 2019 Inpatient Prospective Payment System (IPPS) proposed payment rule. While OHA is working with our consultant on an in-depth analysis, a few key points and issues have already emerged in our review.
The proposed rule reflects the annual updates to the M
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05/31/2018
CMS on May 8 published its Proposed Fiscal Year 2019 Medicare Inpatient Rehabilitation Facility Prospective Payment System, or IRF, Rule Update. The rule proposes to increase the IRF Standard Conversion Factor 1.15 percent.OHA’s Payment Rule Brief can be found at the link here.
Please contact Shawn Stack with any questions.
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05/31/2018
CMS on May 8 issued its Proposed Fiscal Year 2019 Medicare Inpatient Psychiatric Facility Prospective Payment System, or IPF, Rule update. The rule proposes to increase inpatient IPF payment rates by a combined 1.4 percent.
OHA’s Payment Rule Brief can be found at the link here.
Please contact Shawn Stack with any quest
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05/31/2018
New Medicare cards are being sent to beneficiaries through April 2019, and a substantial transition period will be in place from through Dec. 31, 2019 for providers to use either the Health Insurance Claim Number, or HICN, or the new Medicare Beneficiary Identifier for all Medicare transactions. Providers can use the myCGS MBI
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05/31/2018
Join the Centers for Medicare & Medicaid Services Chicago Regional Office webinar series beginning June 6. This new series includes webinars on the Quality Payment Program, new Medicare card project and Medicare provider enrollment process. Each webinar includes a question and answer session.Quality Payment Progra
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05/31/2018
Still time to register for the OHA Annual Meeting & Education Summit to be held June 4-6. Join members of the Ohio hospital community June 4-6 in Columbus for the 103rd Annual Meeting and Education Summit. The three-day event features more than 80 education sessions, keynote presentations by national leaders and special recognit
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05/31/2018
Archive Copy: May 8 OHA Webinar on ODM Retrospective Claims Review OHA and KEPRO hosted a webinar May 8 10, "KEPRO: ODM Retrospective Claims Review" An archive copy of the webinar is available here. A copy of the ODM PowerPoint presentation for the session is available here.
The Ohio Bureau of Workers&rs
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04/30/2018
The Centers for Medicare & Medicaid Services on April 24 issued its Proposed Fiscal Year 2019 Medicare Inpatient Prospective Payment System, or IPPS, Rule update. The rule proposes to increase inpatient operating rates by 1.75 percent and continue to push many of the administration’s health care promises such as reduction
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04/30/2018
The Centers for Medicare & Medicaid Services on May 27 issued its proposed rule to update payment rates for inpatient psychiatric facilities for fiscal year 2019. CMS proposes a net payment increase of 0.98 percent over payments in FY 2018. This includes a 2.8 percent market-basket update, minus 0.8 percent for productivity and
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04/30/2018
The Centers for Medicare & Medicaid Services issued its FY2019 proposed IRF rule to update payment rates for inpatient rehabilitation facilities. CMS proposes a net payment increase of 0.9 percent over payments in FY 2018. The overall update to the payment rate includes a 2.9 percent market-basket update, minus 0.8 per
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04/30/2018
Parity@10 is a three-year campaign to establish effective models for robust enforcement of the Mental Health Parity and Addiction Equity Act in 10 states, including Ohio, and to disseminate those models across the country. The campaign’s goal is to ensure insurance carriers and state Medicaid programs offer fully parity c
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04/30/2018
The Ohio Department of Medicaid last month announced a proposal to recalibrate Medicaid relative weights (both APR-DRG and EAPG). ODM shared a fiscal analysis of the recalibration, which indicated this would reduce hospital payments by $84.4 million per year using 100 percent of fee-for-service pricing, and OHA hosted a March 2
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