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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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OHA Meeting with State Leaders on 2 Critical Medicaid Payment Issues

10/31/2017

The Ohio Hospital Association, along with other provider associations, met Oct. 5 with the directors of the Governor's Office of Health Transformation and the Ohio Department of Medicaid as well as a representative from the Governor's office to hear updates on plans to move forward on two issues of key importance to the hosp Read More . . .

ODM Rate Cut Rule Filed

10/31/2017

As expected, the Ohio Department of Medicaid filed the rule implementing a 5 percent hospital rate cut. See the rule, the public notice, and other documents here. Note that the public hearing and deadline for written comments is Nov. 17. OHA plans to oppose this rule. OHA will be in touch with more information soon on outreach plan Read More . . .

OHA Releases Patient Education Letter Template in Response to Anthem’s Radiologic Policies

10/31/2017

The Ohio Hospital Association on Oct. 12 released a patient communication template hospitals can use to communicate with patients impacted by Anthem BCBS’s new outpatient radiologic policy implemented in Ohio on Sept. 1.   The template  assists hospitals in explaining the benefits patients may want to consider Read More . . .

OHA Releases Preliminary Hospital-Specific 2018 UPL Payment Data

10/31/2017

OHA on Oct. 11 posted the projected 2018 Upper Payment Limit amounts due to hospitals here. UPLs were calculated in this preliminary run to be $488.3 million statewide, which is $50 million (or 9.3 percent) lower than SFY 2017 payments. Most hospitals will see a decline due to continued erosion of traditional Medicaid fee-for-servi Read More . . .

CMS Releases Correction Notice for Final FY 2018 Medicare IPPS and LTCH Update

10/31/2017

The Centers for Medicare and Medicaid Services have issued a correction notice to the FY 2018 final inpatient prospective payment system and Long-term Care Hospital rule that was released on Aug. 14. The notice amends the IPPS operating and capital related costs, with impacts to long-term care hospitals as well and is effective retr Read More . . .

CMS Releases Correction Notice for Final FY 2018 Medicare SNF PPS Rates, Wage Index Values

10/31/2017

The Centers for Medicare & Medicaid Services issued a correction notice to the FY 2018 skilled nursing facility prospective payment system rates and wage index values. The notice corrects the FY 2018 SNF PPS wage index budget neutrality factor and per diem rates based on correlation to the error in the wage data that was us Read More . . .

CMS Issues Instructions for Worksheet S-10

10/31/2017

The Centers for Medicare & Medicaid Services issued new and revised instructions for charity care and bad debt data reported by hospitals on worksheet S-10 of the Medicare Cost Report. This data is now used for the distribution of Medicare Disproportionate Share Hospital, or DSH, funding. See this Medicare Learning Network Read More . . .

Window Extended for Hospitals to Amend CMS Worksheet S-10 Reporting

10/31/2017

The Centers for Medicare & Medicaid Services has extended the window from Oct. 31 to Jan. 2, 2018 for hospitals to amend uncompensated care, bad debt and other Worksheet S-10 reporting on their fiscal year 2014 and 2015 Medicare cost reports.   Proper reporting of S-10 data is critical, as it is now us Read More . . .

CareSource Shows Good-Faith in Resolving Claims Issues

10/31/2017

Ohio Hospital Association representatives met with CareSource’s Ohio president, vice president of Ohio Market Operations and Ohio Government Affairs director Oct. 3 in Columbus to talk through CareSource’s plan to address communication and claims issues that have been impacting payments and taxing administrative resource Read More . . .

CMS Quality Payment Program Fall Series Begins

10/31/2017

If you are affiliated with a hospital or provider and interested in learning more about the Quality Payment Program, the Centers for Medicare & Medicaid Services fall educational series has started. For general QPP information, click here. CMS fall educational schedule:  QPP MIPS Scoring Methodology - Noon (CT) Nov. Read More . . .

Don't Miss Medicare’s Open Enrollment Period Oct. 15 – Dec. 7

10/31/2017

Medicare health and drug plans can make changes each year on cost, coverage, network providers and pharmacies. All enrollees in Medicare can change their health plans and prescription drug coverage for 2018 to better meet their personal needs between Oct. 15 to Dec. 7.Please make certain hospital registration staff are aware of this Read More . . .

Don't Forget: Medicare Beneficiary Identifier Begins April 1, 2018

10/31/2017

The Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, requires Centers for Medicare & Medicaid Services to remove Social Security Numbers from all Medicare cards by April 2019. CMS will respond with randomly generated Medicare Beneficiary Identifiers starting next spring. Medicare identifiers will replace the Heal Read More . . .

Ohio AG Office Begins Reimbursement for HIV Prophylaxis Under SAFE Program

10/31/2017

The Ohio Attorney General’s Office on Oct. 3 began reimbursing for HIV Prophylaxis as part of the Sexual Assault Forensic Exam Program. In July 2017, the Ohio legislature approved language within the SAFE statute to add payment for HIV prophylaxis when directly related to a sexual assault and done in conjunction with forensic Read More . . .

Just the Facts - October 2017

10/31/2017

An archived Copy of Oct. 10 OHA Health Economics & Policy webinar "KEPRO: ODM Retrospective Claims Review Webinar" is availablehere. A copy of the PowerPoint is available here. A copy of the Q&A document is available here.An archived Copy of Oct. 24 OHA Health Economics & Policy webinar "Ohio Medicaid 2018 Read More . . .

Hold the Dates - October 2017

10/31/2017

OHA’s Nov. 2 Health Economics & Policy Webinar will cover a review of Ohio Bureau of Workers’ Compensation’s proposed 2018 hospital outpatient reimbursement and polices, as well as best practices in BWC billing and coding. OHA members may register here.OHA’s Nov. 9 Health Economics & Policy Webinar wi Read More . . .

OHA Group Secures ODM Agreement to Revisit Cuts; State Officials Still Can’t Explain Projected Shortfall

09/29/2017

A group of Ohio hospital leaders led by OHA Board Chair Kevin Webb (ProMedica) and Chair-elect Bruce White (Knox Community Hospital) met with Ohio Department of Medicaid actuaries and staff on Sept. 18 to press for the rationale behind $690 million in additional hospital cuts announced after the state budget was approved end of June Read More . . .

OHA Demands Anthem Rescind New Imaging Policies

09/29/2017

The Ohio Hospital Association, through legal counsel Bricker & Eckler LLP, has demanded Anthem rescind its adoption of a retroactive review process of the medical necessity of all MRIs and certain CT scans performed in hospital emergency departments and dually pending claims for clinical reviews billed with high-tech imagin Read More . . .

Transparency Lawsuit Hearing Delayed

09/29/2017

The Williams County Court of Common Pleas on Sept. 21 announced the preliminary injunction hearing regarding OHA’s challenge to the price transparency law is delayed from next week's scheduled dates of Sept. 26-27 until Dec. 20-21. The Court’s order also combines the preliminary injunction hearing with the permanent Read More . . .

OHA Comments on Proposed Medicare Hospital Payment System Changes for 2018

09/29/2017

OHA submitted comments Sept. 11 to the Centers for Medicare & Medicaid Services on the proposed rule to implement the Affordable Care Act’s Medicaid DSH reductions. In the letter, OHA requested CMS make changes to its proposals regarding alternative payment methodology for 340B pricing program, the inpatient-only list, re Read More . . .

CMS Extends Deadline for S-10 Reporting Changes to Oct. 31

09/29/2017

CMS notified OHA it has extended the window for hospitals to amend uncompensated care, bad debt and other Worksheet S-10 reporting on their fiscal year 2014 and 2015 Medicare cost reports from Sept. 30 to Oct. 31. Please remember proper reporting of data on Worksheet S-10 is critical, as it will drive the distribution of inpatient Read More . . .

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