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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
 

ODM Finalizes SFY 2019 UPL Payments

11/29/2018

In collaboration with OHA, the Ohio Department of Medicaid yesterday finalized the payment amounts, by hospital, for the SFY 2019 Upper Payment Limit program. Minor data corrections have been made to the preliminary calculations, and many hospitals will see slight changes in upcoming second, third and fourth quarterly UPL distributi Read More . . .

ODM Changes Utilization Review Vendor

11/29/2018

The Ohio Department of Medicaid has announced a new hospital utilization review vendor. Effective Dec. 1, HMS Permedion will assume responsibility for processing: Home health prior authorizationsBehavioral health prior authorizations for Medicaid fee-for service consumers not participating in a managed care planHospital medical-s Read More . . .

OIG Identifies Vulnerabilities In Hospital Wage index

11/28/2018

The U.S. Department of Health and Human Services' Office of Inspector General on Nov. 27 released a report identifying vulnerabilities in the hospital wage index system that impact Medicare payments to providers. The report goes on to state ways in which the current data used to calculate wage indexes is not always an accurate r Read More . . .

CMS Launches Online Tool to See Costs for Common Surgical Procedures

11/27/2018

The Centers for Medicare & Medicaid Services on Nov. 27 launched a new online tool that allows consumers to compare Medicare payments and co-payments for certain procedures that are performed in both hospital outpatient departments and ambulatory surgical centers. The Procedure Price Lookup tool displays national averages for th Read More . . .

CMS Hosting Electronic Health Record Incentive Program Dec. 5th

11/26/2018

The Centers for Medicare & Medicaid Services will host a webinar on Dec. 5 to review changes to the EHR Incentive Program for 2019 and 2020 as a result of the 2019 inpatient prospective payment system final rule. Providers can register for webinar here. Contact Shawn Stack with questions.   Read More . . .

OHA’s Admitting, Billing & Collection Committee Meets with CareSource on Operational Updates

11/23/2018

CareSource leadership on Nov. 14 provided updates to OHA’s Admitting, Billing & Collection Committee on a list of outstanding issues OHA has been monitoring and pushing for resolution on with the Medicaid managed care payer. Following the plan’s status update to committee members, OHA and the committee reviewed addi Read More . . .

CMS Approves HCAP for 2018; OHA, ODM Finalize Schedule

11/20/2018

The Centers for Medicaid & Medicare Services today approved the Ohio Department of Medicaid’s state plan amendment, governing the assessment and distribution formulas for HCAP in federal fiscal year 2018. OHA worked with ODM to finalize the schedule of assessments and payments, as follows: HCAP letter sent to hospita Read More . . .

UHC Announces Prior Authorization for Site of Care Outpatient MR/CT Services

11/15/2018

United Healthcare in October announced in its Provider Bulletin that the payer would be requiring specific criteria be met to support medical necessity when performing advanced radiological imaging procedures in hospital outpatient departments. UHC stated said one of the following criteria must be met to perform advanced radiologic Read More . . .

OHA Reminds Members Location Addresses on Claims Must Match CMS Records

11/15/2018

Ohio’s Medicare Administrative Contractor, CGS, wants to make certain hospitals are verifying off-campus, outpatient, provider-based department location addresses on claims match exactly the address that has been provided and updated to CMS’ PECOs system.   CMS must begin to activate systematic validation edi Read More . . .

OHA Provides Toolkit for Complying with New Federal Rule on Posting Standard Charges

11/12/2018

On Jan. 1, 2019 a new federal rule goes into effect that requires hospitals to post their “standard charges” on the hospital’s website in a “machine readable” format. OHA has prepared a toolkit for hospital members to assist in understanding the rule’s requirements and communicating with pati Read More . . .

2018 HCAP On Hold

11/12/2018

OHA had previously reported a start date of Nov. 14 for 2018 HCAP. This has been delayed to a date yet to be released due to the rulemaking process taking longer than the Ohio Department of Medicaid had anticipated. OHA staff has been assured by ODM that 2018 HCAP will be completed by Christmas. Read More . . .

New Medicare Card Mailing Update – Wave 6 Ends

11/12/2018

CMS finished mailing cards to people with Medicare who live in Waves 1-5 and is begining distribution in wave 6 states (Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Texas, Utah, Washington and Wyoming). Card mailing in Wave 7 states and territories continues. Ohio is in Wave 7. If someone with Medicare says they did Read More . . .

OHA Releases Brief on CMS Final CY 2019 OPPS Rule

11/09/2018

CMS on Nov. 2 published its final calendar year 2019 Medicare Outpatient Prospective Payment System Rule Update. The rule proposes to increase the OPPS Payment Rate +1.09 percent from the CY 2018 OPPS conversion factor.OHA’s Payment Rule Brief can be found at the link here. Please contact Shawn Stack with any questions. Read More . . .

Ohio BWC Seeks Comments of Proposed 2019 OPPS and ASC Rules

11/06/2018

Ohio Bureau of Workers' Compensation seeks comments through Nov. 16 on two proposed fee schedule rules. After review, OHA is preparing comments to submit on Outpatient Hospital Reimbursement Rule, Ohio Administrative Code 4123-6-37.2 to become effective May 1, 2019 and the current Ambulatory Surgical Center Services Rule, Ohio Read More . . .

CMS Releases OPPS, PFS, Home Health, QPP Fact Sheets

11/06/2018

Medicare recently published fact sheets summarizing the 2019 final rules for: Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC)Physician Fee Schedule (PFS)Home Health Prospective Payment SystemQuality Payment Program (QPP) Please contact Shawn Stack with questions.   Read More . . .

CMS Publishes Final CY 2019 Physician Fee Schedule Rule

11/02/2018

The Centers for Medicare & Medicaid Services on Nov. 1 issued its final rule updating calendar year 2019 Physician Fee Schedule. The CY 2019 Physician Fee Schedule has a conversion factor of $36.04, a small increase over the CY 2018 rate of $35.99 which also reflects a budget-neutrality adjustment required by law and an update Read More . . .

CMS Publishes Final CY 2019 Rule

11/02/2018

The Centers for Medicare & Medicaid Services on Nov. 2 issued its final rule updating calendar year 2019 Hospital Outpatient Prospective Payment, or OPPS, and Ambulatory Surgical Center, or ASC, Payment System and Quality Reporting Programs. Highlights of the final rule:Cuts payments for clinic visits in grandfat Read More . . .

The VA Choice Program

11/01/2018

The Veterans Administration announced Oct. 2 in a press release that the Triwest contract will extend and expand to cover the entire country for the Patient-Centered Community Care, PC3, and Veterans Choice Program, or VCP.  A press release fromTriWest provided more details regarding the expansion plans. TriWest stat Read More . . .

October HCAP Model Update

11/01/2018

There has been a small update to the 2018 HCAP model. Heather Hill Care Communities closed during the program year, and the model has been adjusted. Because this hospital was not going to receive a net gain, this will not substantially change the closed hospital or statewide residual pots. Data for the time when the hospital was clo Read More . . .

Ohio Medicaid: Restricted Medicaid Coverage

11/01/2018

The Ohio Department of Medicaid on Nov. 1 proposed rule 5160:1-6-06.5 on how to calculate and apply a restricted Medicaid coverage period when an institutionalized individual improperly transferred an asset. Differences between this rule and the rule it is replacing are the addition of language regarding about how to calculate Read More . . .

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