Finance News

The latest news and updates on federal and state hospital and health system reimbursement policies and procedures.

View OHA's monthly finance alert wrap up - By the Numbers


Hospital Executives Testify to HHS Finance Subcommittee Against State Budget Cuts, Non-Contracting Language


A panel of health care executives testified Wednesday before the Ohio House Finance Subcommittee on Health and Human Services against hospital payment cuts and non-contracting language proposed in House Bill 49, the 2018-2019 state operating budget.   The panel included member hospital executives Ray Chorey, president, Southe Read More . . .

Performant Recovery has sent out the first round of ADRs


The Recovery Audit Contractor (RAC) verified late yesterday with OHA that ADRs have been printed and sent out to Ohio hospitals!   Performant Recovery, with locations in Livermore, CA and San Angelo, TX, was awarded the recent RAC Contract for Region One: Michigan and Indiana (J8 WPS MAC jurisdiction), Ohio and Kentucky (J15 Read More . . .

2016 OHA Lobbying Expenditure Letter Available


The OHA 2016 Lobbying Expenditure Letter is available here. In accordance with federal tax law, the Internal Revenue Service requires hospitals and other facilities to apportion trade association dues related to lobbying expenses. Read More . . .

Medicaid Requirements for 340B Covered Entities (5160-1-17.11) – Resubmission Date to JCAR Delayed Until Apr. 17… At least!


The Ohio Department of Medicaid on March 6 withdrew rule 5160-1-17.11, Requirements for 340B Covered Entities, which in part required covered entities to include modifiers on outpatient claims with 340B drug lines where the hospital was seeking reimbursement for the drug provided. The rule also set ODM’s status reporting requi Read More . . .

CareSource Updates OHA and Large Provider Group on NCD/LCD Claim Edits, Claims Recoupments and Reprocessing, Provider Credentialing Delays and System Enhancements


CareSource Vice President of the Ohio Market Operations Dan Hounchell yesterday reported to OHA’s Admitting, Billing and Collection Committee and Large Provider Group that CareSource is committed to work on resolving outstanding payment recoupment issues, edit and denial challenges and unlinked/undocumented medical policies. O Read More . . .

OHA Health Economics & Policy Webinar: Best Practice in Audit Response


An archive recording of the March 14 OHA Health Economics & Policy webinar Best Practice in Audit Response is available here.  A copy of the PowerPoint is here and a copy of Bluemark’s esMD program handout is available here.  contact Shawn Stack with questions. Read More . . .

March 9 Behavioral Health Redesign Webinar


A recording of the March 9 webinar on Behavioral Health Redesign is available here. A copy of the slides is available here. Contact Aly DeAngelo with any questions.  Read More . . .

CMS Posts MOON FAQs Online


The CMS has posted frequently asked questions concerning the Medicare Outpatient Observation Notice (MOON).  The “MOON FAQs” are available on the CMS website.    High level directives are offered on how hospitals should be completing the free-text fields on the form specifically to the field stating   Read More . . .

The Department of Veterans Affairs Presents Helpful Reference Materials


The Department of Veterans Affairs presented helpful resource materials to hospitals last month at the Feb. HFMA/AAHAM Conference in Akron, Ohio. The Ohio Hospital Association has posted the following VA reference materials to our website for easy access and review: VA Rejection/Denial Reasons with Definitions VA Appeal Read More . . .

CMS Social Security Number (SSN) Removal Initiative


The Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, requires CMS to remove Social Security Numbers from all Medicare cards by April 2019 and CMS will respond with randomly generated Medicare Beneficiary Identifiers, starting this spring. Medicare identifiers will replace the Health Insurance Claim Number on Medicare Read More . . .

Performant Recovery has been Granted Permission to begin sending ADR’s by CMS.


The Recovery Audit Contractor (RAC) has stated that they will be tying up a few loose ends on their side and will then begin activity in the next few weeks.   Performant Recovery, with locations in Livermore, CA and San Angelo, TX, was awarded the recent RAC Contract for Region One: Michigan and Indiana (J8 WPS MAC jurisdicti Read More . . .

Medicaid Requirements for 340B Covered Entities (5160-1-17.11) - Withdrawn


The Ohio Department of Medicaid withdrew rule 5160-1-17.11, “Requirements for 340B Covered Entities” on March 6, 29017 which in part required covered entities to include modifiers on OP claims with 340B drug lines where the hospital was seeking reimbursement for the drug provided. The rule also set forth ODM’s stat Read More . . .

Additional Assessment and Distribution for 2014 HCAP


Because CMS under-estimated inflation relating to the 2014 HCAP model, there are additional federal funds available for distribution. Per the standard HCAP process, hospitals will be assessed a small fee in order to collect the federal matching dollars. ODM will be mailing an assessment letter to hospitals on March 10 and the assess Read More . . .

ODM Releases Updated PPR Report Cards


The Ohio Department of Medicaid has updated Potentially Preventable Readmissions report cards for calendar years 2012 through 2015 available here. The health care quality initiative based on readmissions for hospital stays helps ODM identify opportunities to reduce readmissions, improve the quality of patient care and save state tax Read More . . .

Budget Focuses Resources on Pay for Value, Population Health


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 Read More . . .

CMS MOON Requirements Effective March 8


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 benefici Read More . . .

Hospitals Report Continued Struggles with CareSource Payment, Edit Policies


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


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


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 . . .

HHS Updates Poverty Guidelines


Section 637(2) of the Omnibus Budget Reconciliation Act of 1981 (42 U.S.C. 9902(2) 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 Read More . . .

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