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

Congress Returns to Face Multiple Health Care Issues


Shortly before the holidays, legislators passed a short-term measure to keep the government open through Jan. 19. The stop-gap measure included $2.85 billion for the Children’s Health Insurance Program through the end of March and $2.1 billion in mandatory funding for the Veterans Choice program; extended the Centers for Medic Read More . . .

Medicaid Under Budget Through First 6 Months


For the first half of the fiscal year, General Revenue Fund spending was $202.4 million, or 1.2 percent, below projections, according to the Legislative Service Commission's Budget Footnotes released last week.   Much of the year-to-date underage was attributable to the Medicaid program, for which GRF spending was $136.1 Read More . . .

Hospitals Encouraged to Appeal Denied Anthem ED Claims


Anthem recently adopted a new payment policy regarding retroactive review of certain advanced imaging services conducted in the emergency department, effective Jan. 1. OHA has expressed serious concerns about this policy and others to Anthem in prior correspondence and has had multiple conversations with the Ohio Department of Insur Read More . . .

ICD-10 Codes Required on Outpatient Prescriptions for Opiates as of Dec. 29


As a result of the new Ohio State Pharmacy Board rule (4729-5-30(B) (14)) that went into effect Dec. 29, prescribers must include the first four characters of the medical diagnosis code (ICD-10) on all outpatient opiate prescriptions so they can be entered by the pharmacy into Ohio’s prescription drug monitoring program, OAARS Read More . . .

OHA Names 2018 Committee Chairs; OHA Thanks Outgoing Leaders


The Ohio Hospital Association committees and task forces help guide OHA’s positions on various health care topics. Incoming committee chairs include: Nan Woldin, St. Vincent Charity Medical Center – Admitting, Billing & Collection CommitteePhilip Ennen, Community Hospitals & Wellness Centers &ndas Read More . . .

Hospital Groups Notify Court of Appeals of 340B Case


The American Hospital Association, the Association of American Medical Colleges and America's Essential Hospitals on Tuesday formally notified the court of their intent to appeal the district court's Dec. 29 decision dismissing the groups' lawsuit that sought to prevent Medicare payment cuts for many hospitals in the 340 Read More . . .

CMS to Host New Medicare Card Project Special Open Door Forum


The Centers for Medicare and Medicaid Services is hosting a special open door forum Jan. 23 from 2 to 3 pm ET. The call will educate State Medicaid Agencies, Medicaid Providers, Managed Care Organizations, Medicaid Partners and other Medicaid stakeholders about the change from Social Security Number-based Health Insur Read More . . .

Molina Healthcare issuing A1 Denials on EOBs Inappropriately


Molina Healthcare confirmed last week to OHA member hospitals that its working to resolve a problem where the Medicaid payer is issuing A1 Denials stating claims/services are being denied. In reality, the services in question appear to be packaged or consolidated services and are not denials at all. This latest issue is creati Read More . . .

ODM Releases Preventable Readmissions Analysis


The Ohio Department of Medicaid has released the most current fiscal analysis of its potentially preventable readmissions program. This report reflects the payments that will go into effect in CY 2018. The penalties are based on state fiscal year data reported every six months. The 2018 penalties are based on state fiscal year 2016. Read More . . .

CareSource Ready for Ohio Medicaid’s 340B Modifier


CareSource leadership announced Dec.29 the managed care company completed verification testing on the Ohio Department of Medicaid’s new SE modifier requirement mandated as of Jan. 1.  ODM’s policy team announced in anotificationto OHA on Nov. 7 that all 340B entities billing on a hospital outpatient UB04 w Read More . . .

2019 Medicare Advantage Part C Proposed Risk Adjustment Changes Released


CMS last week announced its proposal to change the risk adjustment model for aged and disabled beneficiaries enrolled in Medicare Advantage Part C for CY 2019. The change, required by the 21st Century Cures Act, proposes changes phased in over a four-year period. CMS proposes adding mental health, substance use disorder and chr Read More . . .

CareSource Contracts with Change Healthcare Contract to Review E/M Codes


CareSource notified its providers at the end of December that the Medicaid managed care payer has contracted with Change Healthcare to review the use of Evaluation and Management, or E/M, codes for all providers as part of ongoing claim review activities. CareSource said Change Healthcare analyzed claims between August 2016 and July Read More . . .

Inpatient Behavioral Health Carve-In for Managed Care Begins January 1


Although most of the behavioral health managed care carve-in is taking effect July 1, 2018, some inpatient services will begin inclusion in Medicaid managed care on Jan. 1, 2018. Patients under 21 or over 65, previously part of the IMD exclusion, will be in managed care beginning Jan. 1 to meet the federal managed care rul Read More . . .

Ohio Medicaid Publishes 2018 Outpatient Covered Codes List


The Ohio Department of Medicaid this week published its full outpatient covered codes list for 2018 on its website under Providers/Fee Schedules Rates/Outpatient Hospital/Covered List.  Hospitals are reminded to review this list of covered codes for 2018 and make certain that edits are set in their patient accounting Read More . . .

ODH Publishes Community Benefit Report; Member Talking Points Provided


The Ohio Department of Health today released its reports on hospital community health improvement spending. These reports are part of guidance issued as a result of the requirements of ORC 3701.981 which requires all tax-exempt hospitals to submit their IRS Schedule H (form 990) to ODH by July 1 annually and for ODH to is Read More . . .

Ohio Hospitals Continue to Work Through Issues with CareSource


The Ohio Hospital Association, Large Provider Group and member hospitals continue to push for resolution on many of CareSource’s unresolved communication, claims and policy issues that have plagued the Ohio Medicaid Managed Care Payer the past year. CareSource’s vice president of Ohio Market Operations, Antoinette Geyer, Read More . . .

Reminder: Ohio Medicaid NDC Code Enforcement Takes Effect Jan. 1


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 Recommends Strategies in Response to Anthem Imaging Payment Policies


The Ohio Hospital Association has heard from some member hospitals regarding concerns with Anthem’s new imaging payment policies. The new payment policy related to hospital outpatient imaging services took effect Sept. 1, and was followed by a new payment policy regarding retroactive review of certain advanced imaging services Read More . . .

Ohio BWC Files 2018 OPPS Final Rule Details


The Ohio Bureau of Workers’ Compensation released its Proposed 2018 Hospital Outpatient Reimbursement Update early in December. Modeled on CMS’ Medicare OPPS, the BWC 2018 OPPS proposal outlines several adoptions such as: Expanding the arthroplasty program by updating six additional procedures to be allowed as ou Read More . . .

Medicare Releases Hospital FAQ on Billing 340B Modifiers


The Centers for Medicare & Medicaid Services on Dec. 13 released Frequently Asked Questions that clarify its new modifier policy for billing 340B-acquired drugs under the outpatient prospective payment system. CMS requires all 340B hospitals begin using one of two new payment modifiers Jan. 1, 2018 as part of its Read More . . .

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