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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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Hospitals’ Advocacy Efforts Continue as Budget Bill Moves to Senate

05/31/2017

The Ohio Senate has been deliberating over the state’s two-year operating budget (Sub. HB 49) and is expected to vote June 21 in advance of the June 30 deadline for the Governor to sign the legislation.   The bill passed the House 58-37 on May 2 mostly along party lines, although a group of conservative lawmakers voted Read More . . .

2017 UPL Payments Revised for 4th Quarter

05/31/2017

The Centers for Medicare & Medicaid Services are requiring the Ohio Department of Medicaid revise the 2017 Upper Payment Limit, or UPL supplemental Medicaid hospital payments, based on the availability of new cost report data. As a result, the payments released in November 2016, unfortunately, are changing, and hospitals wi Read More . . .

Final 30-Day Window Opens for Changes to SFY 2016 Cost Reports

05/31/2017

The final 30-day window for all hospitals to change their cost report data has opened and now closed on Tuesday, May 30. To make changes during this period, each hospital had to pay a “cover charge” equal 0.03 percent of its adjusted total facility costs.   Now that the 30-day window has closed, all SFY 2016 cost Read More . . .

NDC Claim Enforcement Takes Effect Jan. 1, 2018

05/31/2017

ODM 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. The data collection requirement was set forth in the Deficit Reduction Act of 2005 an Read More . . .

3M CGS EAPG Desktop Grouper Settings Released

05/31/2017

ODM has shared its 3M CGS Desktop EAPG Grouper Settings with OHA so hospitals can set their 3M Desktop Groupers to test EAPG claim impacts. ODM prepared the following list of changes to the schedule set-up module so that hospitals can adjust the settings accordingly to mirror those at Ohio Medicaid’s grouper. These items were Read More . . .

ODM, Managed Care Plans 835 Remit to Return EAPG Information to Hospitals

05/31/2017

The Ohio Department of Medicaid and the state's Medicaid managed care plans will return EAPG information on the Electronic Remittance Advice 835 Loop Segment. ODM and the plans will use the 1S qualifier in REF01 to indicate when an EAPG is present on the line detail, which will then trigger the REF02 field to populate the actual Read More . . .

3M Offers OHA Hospitals Group Discount on EAPG Software

05/31/2017

3M is offering Ohio hospitals a group discount on its Enhanced Ambulatory Patient Group classification software, which will be used in the new Ohio Medicaid outpatient prospective payment system, currently scheduled for implementation on July 1. This offer is available through Aug. 1. The discount is similar to what 3M offered for Read More . . .

New Rules Anticipated for 340B Entities Billing 340B Drugs

05/31/2017

The Ohio Department of Medicaid is preparing to introduce, for adoption, a new rule to implement the requirements of a 340B entity to inform the department that it is: 340B, will or will not be using 340B drugs for Medicaid recipients and will use a specific modifier when 340B drugs are used for Medicaid claims. Background: C Read More . . .

Outpatient Hospital Behavioral Health Services Website Updated

05/31/2017

The ODM Policy Team announced on May 25 shared with OHA that updates have been posted to the Departments Outpatient Hospital Behavioral Health Services website under the Departments Fee Schedule and Rates webpage. Updates to the website include: coding charts, modifiers, revenue center codes and hospital slide deck updates.   Read More . . .

OHA Launches Medicaid Provider Complaint Spreadsheet

05/31/2017

OHA worked with the Ohio Department of Medicaid’s Bureau of Managed Health Care to develop a user friendly provider complaint form spreadsheet. The Provider Complaint Spreadsheet can be emailed to Jessica Hughes when multiple claim ICNs are impacted by the same managed care issue.   OHA and the Department requests Read More . . .

Mandatory Comprehensive Care for Joint Replacement Model Delayed Until Jan. 1, 2018

05/31/2017

The Center for Medicare & Medicaid Services announced on May 18 that it will be further delaying the start of the CJR expansion, bundled payment model to Jan. 1. The CJR expansion was to go begin on Oct. and will now begin on Jan. 1 along with the heart attack and cardiac bypass surgery services bundled payment program and the n Read More . . .

State Innovation Waiver Checklist Issued

05/31/2017

The Center for Medicare & Medicaid Services on May 11 published a checklist for states to apply for a Section 1332 State Innovation Waiver. This waiver allows states to “pursue innovative strategies for providing… access to high quality, affordable health coverage.” Section 1332 of the Affordable Care Act allo Read More . . .

Performant Recovery: Region 1, Region 5 Update

05/31/2017

Performant Recovery’s Roxanne Cooksey, director of Healthcare Operations, and Ted Doyle, vice president, Healthcare Markets and project manager of Region Five, provided the OHA Admitting, Billing and Collection Committee with a Recovery Audit Contractor Update on May 17. Cooksey reviewed the 26 CMS approved issues for Region Read More . . .

Just the Facts - May 2017

05/31/2017

OHA has archived a copy of the April 26 OHA Health Economics & Policy webinar Q&A’s Preparing for a Successful EAPG Implementation here. Please note additional questions, concerns and inquiries may still be submitted to BKD’s Jennifer Goins or OHA’s Shawn Stack for review and answer. An archive Read More . . .

Hold the Dates - May 2017

05/31/2017

The Ohio Hospital Association invites hospital professionals from across the state and corporate partners to attend the 2017 OHA Annual Meeting, June 12-14 in Columbus.   The OHA Annual Meeting offers a premier opportunity for health care providers and administrators at all levels to gain valuable insight about Read More . . .

ODH Issues Final Guidance on Schedule H Reporting

04/28/2017

HB 390 (ORC 3701.981) of the 131st General Assembly requires all tax-exempt hospitals to submit their community health needs assessments and improvement plans to the Ohio Department of Health. Additionally, tax-exempt hospitals are required to submit their IRS Schedule H (Form 990) and corresponding attachments to ODH on an annual b Read More . . .

ODM Delays Behavioral Health Redesign

04/28/2017

Following OHA’s March 9 webinar on behavioral health redesign, several member hospitals raised issues with what they heard, and the Ohio Department of Medicaid changed required redesign elements for hospitals. See the revised slide deck here. Specifically, those changes include delaying the termination of the 84 and 95 provide Read More . . .

2011 DSH Audit Recoupment Underway

04/28/2017

ODM on April 24 mailed recoupment letters to hospitals with dollars to be recouped according to the 2011 DSH Audit prepared by Myers and Stauffer. A sample letter can be found here. The letters were only sent to hospitals affected by this recoupment, so most will not receive a letter. If your hospital is one of those impacted, the r Read More . . .

340B Requirements Shifting

04/28/2017

ODM on April 17 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 requirements for Ohio Medicaid p Read More . . .

Medicare FFY 2018 Inpatient PPS, LTCH PPS, Inpatient Psychiatric Proposed Rules Released

04/28/2017

CMS this month released its annual proposed rules to define its provider prospective payment systems. The proposals cover federal fiscal year 2018, the final rule is estimated to be published on Aug. 1 and will mostly go into effect Oct. 1. Comments will be accepted through June 13. OHA will hold a membership webinar on the proposed Read More . . .

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