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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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Ohio Medicaid Proposes Hospital Inpatient, Outpatient Recalibration

03/30/2018

During a March 22 meeting with OHA's team, Ohio Department of Medicaid staff and department consultants from Burns & Associates outlined their proposal to recalibrate Medicaid relative weights (both APR-DRG and EAPG weights) to be effective July 1. They also shared a fiscal analysis of the recalibration, which indicated Read More . . .

OHA Group Defines Metrics to Measure Telehealth Effectiveness

03/30/2018

As evidenced by the successful innovation and intervention happening in hospitals across our state, telehealth is providing increased access to care, lowering costs and improving patient satisfaction and clinical outcomes for Ohioans. However, according to the new Hospital Insights published by the Ohio Hospital Association, there a Read More . . .

Ohio SIM: Episode Based Payment Updates

03/30/2018

To date, the Ohio Department of Medicaid, in collaboration with the Governor’s Office of Health Transformation, has designed and launched reporting on 43 episodes of care. Nine of these episodes are currently linked to financial incentives.   In line with ODM’s thresholding methodology, quality metric thresholds fo Read More . . .

Ohio Medicaid Restructuring Provider Payment Cycles

03/30/2018

The Ohio Department of Medicaid announced last week that there will be a permanent one-week delay in weekly payment cycles beginning April 5. The change will not impact the timing of ODM's HCAP or UPL payments. However, it will affect those UPL payments that ODM makes after the upload for primary UPL payment, as they generally a Read More . . .

Buckeye Health Plan Updates on Behavioral Health, EAPGs, TeleHealth

03/30/2018

Buckeye Health Plan met with OHA’s Admitting, Billing & Collection Committee on March 21 and presented updates on Buckeye’s continued focus to support the state of Ohio through multiple product lines: Medicaid, Medicare, MyCare, Ambetter and Medicare Advantage products. Buckeye updated the ABC Committee on the statu Read More . . .

MITS Fixes In Place

03/30/2018

The Ohio Department of Medicaid updated OHA that the following MITS fixes were implemented on March 21. ODM amended:   Incorrect duplicate denials within and across dates of service for pharmaceutical details on outpatient invoice claimsOutpatient crossover claims are not correctly calculating reimbursement when Medicaid is t Read More . . .

ODM Guidelines for Hysterectomy, Sterilization, Abortion Certification Forms Published

03/30/2018

The Ohio Department of Medicaid on March 14 published its guidance to complete:   DM 03197, Abortion Certification FormODM 03199, Acknowledgement of Hysterectomy InformationU.S. Department of Health and Human Services Form HHS-687, Consent for Sterilization Click here for the guidance information. The revised forms Read More . . .

CMS Begins Low Volume Appeals Settlement Process

03/30/2018

The Centers for Medicare & Medicaid Services on Feb. 5 started accepting expressions of interest for the Low Volume Appeals settlement process. The LVA settlement option is for providers, physicians, and suppliers (appellants) with:   Fewer than 500 appeals pending at the Office of Medicare Hearing and Appeals and th Read More . . .

CMS to Expand Patient Access to E-health Records

03/30/2018

The Centers for Medicare & Medicaid Services announced MyHealthEData this week, a federal initiative to expand patients electronic access to their medical data. The White House Office of American Innovation will lead the initiative, which will also include the U.S. Department of Health and Human Services' Office of the Read More . . .

CGS Introduces Comparative Billing Report

03/30/2018

CGS has introduced the Comparative Billing Report for hospitals via the myCGS Web portal. The CBR shows providers/suppliers their specific billing pattern data in comparison to peer groups within the state and the CGS jurisdiction. CGS intends the information to be helpful in conducting education and self-audit activity. Read More . . .

Federal Court Voids CMS Rule on Medicaid DSH Audits

03/30/2018

The U.S. District Court for the District of Columbia on March 6 voided the CMS rule regarding how third-party payments, such as private insurance or Medicare, are treated for purposes of calculating the hospital-specific limitation on Medicaid disproportionate share hospital, or DSH, payments. The DSH Rule, issued in April 201 Read More . . .

Reminder: Review BWC 2018 OPPS Final Rule Details

03/30/2018

Please take time to review the Ohio Bureau of Workers’ Compensation proposed rules released on Feb. 13 to update  2018 Hospital Outpatient Reimbursement located here. A public hearing for the rule is scheduled for March 22.   BWC historically models rate setting and billing rules in coordination with Medicare&rsquo Read More . . .

Hold the Dates - March 2018

03/30/2018

Save Tuesday, April 10 from 10 a.m. to noon for OHA’s Health Economics & Policy Webinar on Medicaid Hospital Reimbursement 101, Franchise Fee Update.Member hospitals can register for the free webinar here. Read More . . .

Just the Facts - March 2018

03/30/2018

Delay of 340B Drug Ceiling Price Rule: The Health Resources and Services Administration is expected to propose a further delay in the effective date of a final rule on drug ceiling prices and civil monetary penalties for manufactures in the 340B drug savings program, according to a notice review at the Office of Management and Budge Read More . . .

Price Transparency Lawsuit Hearing Further Delayed

02/28/2018

The hearing on OHA’s lawsuit challenging the health care price transparency law has been delayed again. Most recently, the hearing was scheduled for March 15-16. However, Judge J.T. Stelzer of the Williams County Common Pleas Court issued an order last week delaying the hearing indefinitely. State Rep. Jim Butler (R-Oakw Read More . . .

Ohio ACA Enrollment Down Slightly for 2018

02/28/2018

Despite the changes the current presidential administration has made to the Affordable Care Act, enrollment in Ohio only decreased 3.6 percent. Data show 238,843 Ohioans signed up for a marketplace plan in 2017 compared with 230,127 in 2018. Please see the Kaiser Family Foundation report for more information. This year will mark an Read More . . .

Federal Budget Tools, Presentations Available

02/28/2018

Following the flurry of budget activity in Washington, D.C., the American Hospital Association has released tools to help explain the many hospital-related elements in the various budget bills to staff and hospital boards. This AHA Legislative Advisory reviews the key provisions of the bill and this PowerPoint slide deck is availabl Read More . . .

Anthem’s New ER Policy: How Hospitals Can Help

02/28/2018

Anthem Blue Cross Blue Shield on Jan. 1 implemented a new policy in Ohio in which it will deny coverage if a patient receives care in an emergency department and Anthem determines the patient’s need for care was not emergent based on Anthem’s retrospective review of the diagnosis.Call to Action: Collect Examples of Patie Read More . . .

Anthem Rescinds Modifier 25 Policy

02/28/2018

In a letter to the American Medical Association on Feb. 23, Anthem rescinded its reimbursement policy related to the physician use of payment modifier 25, set to take effect on March 1 across the company's commercial health insurance businesses. Anthem made the decision not to proceed with rolling out the policy even though the Read More . . .

Hospital Associations Urge Court to Stop 340B Payment Cut

02/28/2018

Thirty-five state and regional hospital associations on Feb. 22 urged the U.S. Court of Appeals for the District of Columbia Circuit to reverse a district court decision and grant a preliminary injunction to stop a nearly 30 percent Medicare payment reduction for many hospitals in the 340B Drug Pricing Program while the American Hos Read More . . .

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