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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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Budget Focuses Resources on Pay for Value, Population Health

02/28/2017

The Governor’s Office of Health Transformation has published a series of briefing papers about the Administration’s state budget proposals which focus on rewarding value in health care and improving population health. Links to each of the topics are provided below. Additionally, an updated copy of the OHA member budget Read More . . .

HHS Updates Poverty Guidelines

02/28/2017

The Omnibus Budget Reconciliation Act of 1981 requires the Secretary of the Department of Health and Human Services to update the poverty guidelines at least annually, adjusting them based on Consumer Price Index for All Urban Consumers. The poverty guidelines are used as an eligibility criterion by the Community Services Block G Read More . . .

CMS MOON Requirements Effective Next Week

02/28/2017

The Centers for Medicare & Medicaid Services will require Medicare Outpatient Observation Notice, or MOON, compliance beginning March 8. Here is the latest update to the MOON, CMS-10611, form instructions.   The MOON is a standard notice that all hospitals and critical access hospitals must provide to all Medicare benefic Read More . . .

Hospitals Report Continued Struggles with CareSource Payment, Edit Policies

02/28/2017

CareSource continues to work with Ohio hospitals on a rash of recoupments, slow-downs in processing, unpublished claims edits and unlinked medical policies. The managed care organization will be meeting with hospital providers from 10 a.m. to 12:30 p.m. March 10 at the Ohio Department of Medicaid in Columbus to discuss next steps to Read More . . .

Medicare Audit Contractor Meeting with Hospitals

02/28/2017

CGS Administrators, LLC, MAC Jurisdiction 15, partnered with Performant Recovery, the new CMS Region One Recovery Audit Contractor for an outreach webinar on Feb. 23. Hospitals met the Performant RAC team and learned about implementation of the new RAC contract, along with reviewing Performant’s website, here.   A copy Read More . . .

State Releases Final SHIP, Guidance

02/28/2017

The state of Ohio released its final State Health Improvement Plan, or SHIP, for 2017-2019 in January. The SHIP is a strategic menu of priorities, outcome objectives and evidence-based strategies designed to address three of Ohio’s greatest health challenges: Mental health and addiction Chronic disease Matern Read More . . .

Hold the Dates - February 2017

02/28/2017

Tuesday, March 14 from 10 to 11 a.m. for OHA’s Health Economics & Policy webinar: RAC Region 1 Update. OHA is presenting the session in cooperation with the Greater New York Hospital Association and Bluemark, LLC. Register here for the webinar. March 9-10 for Ohio Workers’ Compensation Medical & Heal Read More . . .

Just the Facts - February 2017

02/28/2017

The Ohio Department of Medicaid’s credentialing backlog is looking better. The Department reported to OHA on Feb.23 that it has made considerable progress in catching up on its six-month back log in credentialing. The Provider Network Management team at ODM said it is currently working on physician credentialing from De Read More . . .

Court Delays Hearing on Price Transparency Suit

02/28/2017

The Williams County Common Pleas Court yesterday granted OHA’s recent motion for continuance of the preliminary injunction hearing date scheduled for March 17. The state did not object to OHA’s motion, and the court’s order delays the hearing date until Aug.14.    This is an important development f Read More . . .

CMS Finalizes Home Health Rules, Beneficiary Protections

01/31/2017

The Centers for Medicare & Medicaid Services finalized rules governing home health agencies that will improve the quality of health care services for Medicare and Medicaid patients and strengthen patients’ rights. These Medicare and Medicaid Conditions of Participation are the minimum health and safety standards a home hea Read More . . .

Hearing Date Extended in Price Transparency Lawsuit

01/31/2017

Judge J.T. Stelzer of the Common Pleas Court of Williams County, Ohio extended the preliminary injunction hearing date from Jan. 20 to March 17 in the lawsuit filed in December to enjoin Ohio's price transparency law from going into effect. This order means the price transparency law will not go into effect, if it goes into eff Read More . . .

CMS Posts Final Hospital MOON Form Instructions

01/31/2017

CMS released its Medicare Outpatient Observation Notice, known as MOON, CMS-10611, form instructions. MOON is a standard notice that all hospitals and critical access hospitals must provide effective March 6, to all Medicare beneficiaries who receive outpatient observation services for more than 24 hours. Under the Notice of Observ Read More . . .

CareSource Increasing Outreach OB Payment, Clinical Edit Policies

01/31/2017

CareSource reported to OHA that it has kicked off a plan to engage provider partners and key provider trade associations. The focus of this plan is to acknowledge challenges over the last couple of years, provide concrete actions that have been put in place to permanently address these issues, and overall strengthen the trust and re Read More . . .

CMS Releases Guidance on Site-Neutral Payment Policy

01/31/2017

CMS released two documents that further clarify the site-neutral payment policy for hospital off-campus provider-based departments. Both the 21st Century Cures Act Sections 16001 and 16002 and the Extraordinary Circumstance Relocation Exception Guidance provide clarity around mid-build provisions as well as “extraordinary circ Read More . . .

State Shares 2017 Expectations for SIM

01/31/2017

The Governor’s Office of Health Innovation continues to develop and implement episodes of care as part of the State Innovation Model grant and Ohio’s efforts toward payment reform. OHT held a webinar Dec. 19 to give an update on progress to date and what to expect in 2017. Most notably, spend thresholds have been set for Read More . . .

OHA Releases 2016 HCAP Model, ODM Mails Assessment Letters

01/31/2017

The Ohio Department of Medicaid and OHA have agreed on the final preliminary model for 2016 HCAP. That model can be found here. Assessment letters were mailed by ODM on Jan. 9, and assessments are due in two installments on Jan. 25 and Feb. 8. Upon receipt of hospital assessments, ODM will make HCAP payments in two installments on Read More . . .

Hold the Dates - January 2017

01/31/2017

Save Thursday, Feb. 23 from 11a.m. to 1 p.m. for an important webinar with Performant Recovery (Medicare’s Region 1 Recovery Audit Contractor), the CMS and CGS Administrators. The webinar will focus on changes to the Recovery Audit Contractor process and familiarizing providers with Performant Recovery. Registration wil Read More . . .

Just the Facts - January 2017

01/31/2017

TriWest Healthcare Alliance VA Claims Issues are Reported to be Resolved. TriWest and the VA have developed a long-term fix to their claims processing and payment backlog, and they are planning to bring all claims current by the end of January. TriWest and the VA are committing additional resources to accelerate payment to pr Read More . . .

Judge Halts Start Date for Ohio Price Transparency Law

12/30/2016

The Ohio Hospital Association and member hospital, Community Hospitals and Wellness Centers in Bryan, Ohio, joined by several other health care provider groups, filed a lawsuit Dec. 22 against the State of Ohio seeking an injunction to enjoin the price transparency law from going into effect Jan. 1, 2017. Judge J.T. Stelzer of the C Read More . . .

OHA Board Endorses Medicaid Hospital Payment Modernization Model

12/30/2016

The OHA Board of Trustees on Nov. 18 endorsed the Finance Committee’s recommendation to approve the latest financial impact model (Model 13), which resolves several program development issues, including the recovery of many managed care claims missing from the department’s files.   Ohio Medicaid continues its effo Read More . . .

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