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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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Provider Update: Early Issues with New Medicare Cards

09/28/2018

Ohioans covered by Medicare should be receiving their new Medicare cards, however the Centers for Medicare & Medicaid Services report some new cards have been accidentally thrown away because they were sent in non-descript envelopes.PLEASE INFORM YOUR MEDICARE PATIENTS when speaking with them regarding appointments and schedulin Read More . . .

Medicare Open Enrollment Begins Oct. 15

09/28/2018

As the 2019 Medicare open enrollment period approaches, Jillian Froment, director of the Ohio Department of Insurance, is encouraging Medicare beneficiaries to review their drug and health insurance coverage options and select a plan that fits their needs and budget.   The Ohio Senior Health Insurance Information Program, a d Read More . . .

OHA Comments on CY 2019 Physician Fee Schedule Proposed Rule

09/28/2018

The Ohio Hospital Association on Sept. 10 submitted comments on the Centers for Medicare & Medicaid Services' Physician Fee Schedule proposed rule for calendar year 2019. OHA offered recommendations with respect to evaluation and management visit code changes, Part B drug reimbursement, expanding access to virtual care and t Read More . . .

Ohio Medicaid Provides Hospitals with Claim Correction Updates

09/28/2018

The Ohio Department of Medicaid's Bureau of Health Plan Policy on Sept. 21 updated hospitals during the Large Provider Group meeting on the following topics:  Medicaid fee-for-service has been discounting or packaging the second day of observation in some cases, and ODM states it has always been its intent to reimburse for Read More . . .

Webinar Available on 2016 DSH Audit

09/28/2018

Myers & Stauffer has pre-recorded a webinar on the 2016 DSH audit process. The webinar can be found here. The slides can be found here. There will be a two-week period to submit question not answered in or arising from the webinar. Submit questions to Daniel Vielhaber by Oct. 8. Myers & Stauffer has informed OHA that its Pr Read More . . .

CareSource Provides Operational Updates to OHA, LPG

09/28/2018

CareSource leadership on Sept. 19 and Sept. 24 provided updates to OHA’s Admitting, Billing & Collection Committee as well as Ohio’s Large Provider Group on a comprehensive list of outstanding issues OHA has been monitoring and pushing for resolution on for more than a year on behalf of member hospitals. The core is Read More . . .

Reminder: Use Dental Codes for Proper Medicaid Reimbursement

09/28/2018

The Ohio Hospital Association and corporate partner BKD recently released quarter 3 reports on the impact Ohio Medicaid’s EAPG grouper has had over the past year on hospital outpatient reimbursement. In the data analysis, OHA and BKD saw a vast under-reporting of D-Codes (Dental Codes) on hospital outpatient claims. Hospital Read More . . .

Reminder: Use Modeling for EAPG Carve-out Payments

09/28/2018

The Ohio Hospital Association and corporate partner BKD recently released quarter 3 reports on the impact Ohio Medicaid’s EAPG grouper has had over the past year on hospital outpatient reimbursement. In the data analysis, OHA saw several scenarios in which hospitals are not seeking reimbursement appropriately for Independently Read More . . .

ODM Releases Episode-Based Payments, CPC Updates

09/28/2018

The Ohio Department of Medicaid in August hosted webinars to update providers on the State Innovation Model grant projects, or SIM. Ohio’s SIM program includes episode-based payments and the Ohio Comprehensive Primary Care Initiative, or CPC. Slides for the CPC webinar can be found here and the SIM webinar here. Look for reco Read More . . .

OHA Comments on Proposed OPPS Rule

09/28/2018

OHA on Sept. 24 submitted comments on the Centers for Medicare & Medicaid Services' Hospital Outpatient Prospective Payment System Fee Schedule proposed rule for calendar year 2019. OHA offered comments on many elements including the reduction of payments on hospital outpatient clinic visits in excepted off-campus provi Read More . . .

Appeals Court Rules on Procedural Issue In Transparency Suit

09/28/2018

The Sixth District Court of Appeals on Sept. 19 upheld the trial court’s decision to deny a motion to intervene in the OHA's challenging a state transparency lawsuit. The court’s decision is available here. The decision can be appealed to the Ohio Supreme Court over the next 45 days. If the Court accepts an appeal, Read More . . .

Don’t Miss OHA’s Annual Medicare, Medicaid Update Seminar

08/31/2018

Hospital executives, in-house counsel, auditors, controllers and reimbursement and patient financial services team members are invited to attend the “Medicare and Medicaid in 2019” seminar Sept. 20 in Columbus. Please note this seminar was formerly known as the Larry and Larry Show.   Each fall, OHA presents a sem Read More . . .

CMS Releases Final FY 2019 Hospital IPPS Rule

08/31/2018

The Centers for Medicare & Medicaid Services on Aug. 2 released its Hospital Inpatient Prospective Payment System final rule for fiscal year 2019. The rule will increase rates by 1.85 percent in FY 2019 compared to FY 2018, after accounting for inflation and other adjustments required by law. The final rule includes an ini Read More . . .

OHA Publishes Final FFY 2019 Medicare IPF Payment Rule Brief

08/31/2018

The final calendar year 2019 payment rule for the Medicare Inpatient Psychiatric Facility Payment System, or IPF, was released Aug. 6. The final rule reflects the annual update to the Medicare fee-for-service IPF payment rates and policies. The final rule includes:    An overall rate increase amount +1.5 percentMul Read More . . .

OHA Publishes Proposed CY 2019 Medicare OPPS Payment Rule Brief

08/31/2018

The proposed calendar year 2019 payment rule for the Medicare Outpatient Prospective Payment System was released on July 25. The proposed rule includes annual updates to the Medicare fee-for-service outpatient payment rates as well as regulations that implement new policies. The proposed rule includes policies that will:   Ch Read More . . .

OHA Publishes Final FFY 2019 Medicare IRF Payment Rule Brief

08/31/2018

The final federal fiscal year 2019 payment rule for the Medicare Inpatient Rehabilitation Facility Payment System, or IRF, was released Aug. 6. The final rule reflects the annual update to the Medicare fee-for-service IRF payment rates and policies. The final rule confirms:    The IRF Standard Payment Conversion Fa Read More . . .

CMS Releases Final FY 2019 Hospice Rule

08/31/2018

The Centers for Medicare & Medicaid Services released its Hospice Final Rule for FY 2019 on Aug. 2 that will take effect on Oct. 1. The rule will increase both aggregate hospice payments and the statutory annual cap by 1.8 percent ($340 million) from FY 2018 levels, based on a hospital market-basket update of 2.9 percent, minus Read More . . .

CMS Releases Final FY 2019 LTCH PPS Rule

08/31/2018

The Centers for Medicare & Medicaid Services released its Long-Term Care Hospital Prospective Payment System Final Rule for fiscal year 2019 on Aug. 2 that will take effect on Oct. 1. The rule will increase rates by a net of 1.0 percent ($35 million), while payment rates for site-neutral cases will increase by a net of 0.4 perc Read More . . .

OHA Transparency Update: Case on Hold Pending Procedural Ruling

08/31/2018

The Ohio Hospital Association filed a lawsuit in December 2016 to prevent an unworkable state law imposing new hospital price transparency requirements from becoming effective in January 2017. To date, OHA has succeeded in preventing the law from going into effect.  The initial court order issued on Dec. 22, 2016 preventing th Read More . . .

Myers & Stauffer Updates Patient Log Template

08/31/2018

Myers & Stauffer updated the Patient Log Template for the 2016 federal DSH audit in the following ways:   Log 10 tab: clarification has been added that charges on this log should correspond with charges reported on Schedule J6 of the Medicaid cost report.New tabs: “Rev Code Crosswalk Instructions” and &ld Read More . . .

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