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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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ODH Publishes Community Benefit Report; Member Talking Points Provided

12/29/2017

The Ohio Department of Health on Dec. 22 released its reports on hospital community health improvement spending. These reports are part of guidance issued for 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 issue a report summarizing t Read More . . .

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

12/29/2017

The Ohio State Pharmacy Board last month finalized a new rule (4729-5-30(B) (14)) requiring prescribers to include the first four characters of the medical diagnosis code (ICD-10) on all prescriptions for controlled substances, which will then be entered by the pharmacy into Ohio’s prescription drug monitoring program, OARRS. Read More . . .

OHA Recommends Strategies in Response to Anthem Imaging Payment Policies

12/29/2017

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 . . .

Inpatient Behavioral Health Carve-In for Managed Care Begins Jan. 1

12/29/2017

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

Ohio Hospitals Continue to Work Through Issues with CareSource

12/29/2017

The Ohio Hospital Association, the Ohio Medicaid Large Provider Group and member hospitals continue to push for resolution 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, Antoine Read More . . .

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

12/29/2017

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 . . .

Ohio BWC Files 2018 OPPS Final Rule Details

12/29/2017

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 Read More . . .

Medicare Releases Hospital FAQ on Billing 340B Modifiers

12/29/2017

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 . . .

New Medicare Cards to Start Rolling Out in April

12/29/2017

CMS continues with plans to replace all Health Insurance Claim Numbers and old Medicare cards with new Medicare beneficiary identifiers on cards over a 12-month rollout beginning April 1, 2018. The Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, requires CMS to remove Social Security Numbers from all Medicare ca Read More . . .

Hold the Dates - December 2017

12/29/2017

Tuesday, Jan. 10 from 10 a.m. to 11 a.m. for OHA’s Health Economics & Policy Webinar “MACRA: What It Means to Your Hospital and Employed Physicians.”OHA is presenting the session in cooperation with BKD, LLP. Registration information will be released in early January. Read More . . .

Just the Facts - December 2017

12/29/2017

All InHealth Claims Must Be Submitted by Dec. 31 as part of the liquidation order issued by the Franklin County Common Pleas Court. The court determined on May 26, 2016 that the insurer was insolvent and ordered liquidated. Under the terms of the liquidation order, some InHealth policies remained in effect until Dec. 31, 2016. The c Read More . . .

No Medicaid Rate Cut for Ohio Hospitals in SFY 2018

11/30/2017

The Ohio Department of Medicaid confirmed Nov. 13 that the department will be withdrawing the 5 percent rate cut rule it submitted on Oct. 17 and will not cut hospital rates for the remainder of state fiscal year 2018.   “OHA appreciates the willingness of the Kasich Administration and Ohio’s General Assembly to e Read More . . .

Transparency Lawsuit Hearing Delayed, New Legislation Introduced

11/30/2017

The Williams County Court of Common Pleas announced the preliminary injunction hearing regarding OHA’s challenge to the price transparency law is delayed from Dec. 20-21 to March 15-16, 2018. The judge indicated that he needs more time to process briefs related to State Rep. Jim Butler’s motion to intervene in the lawsui Read More . . .

OHA Finance Committee Studies Franchise Fee Reforms

11/30/2017

For the better part of this year, the OHA Finance Committee has examined challenges presented by the existing franchise fee – growing fees resulting from hospital expense growth, shrinking traditional Medicaid caseloads that lead to shrinking Upper Payment Limit payments and new federal policies preventing the expans Read More . . .

OHA's EAPG & Biennium Budget Monitoring Project Update

11/30/2017

OHA and corporate partner BKD continue to work with member hospitals in securing agreements for the EAPG & Biennium Budget Monitoring Project for state fiscal years 2018 and 2019.   If you would like to participate in the Base Package, please notify Shawn Stack if you haven’t already done so, and he will i Read More . . .

2018 Final Medicare Outpatient Prospective Payment System Rule Analyzed

11/30/2017

Earlier this month, the Centers for Medicare & Medicaid Services issued the 2018 outpatient prospective payment system/ambulatory surgical center final rule. In addition to standard updates, the rule implements significant cuts to non-exempted services furnished in off-campus provider-based departments and to nonpass-throug Read More . . .

House Passes CHIP Extension, Medicaid DSH Relief

11/30/2017

The U.S. House voted 242-174 on Nov. 3 to pass a five-year funding extension for the Children's Health Insurance Program, which expired in September. But partisan disputes over funding offsets leave it unclear when legislation to reauthorize the popular program will actually be signed into law. The Championi Read More . . .

CMS Issues MACRA, Physician Payment Rules

11/30/2017

The Centers for Medicare & Medicaid Services on Thursday issued its final rule for the physician fee schedule for calendar year 2018. CMS estimates a 0.41 percent increase in physician payment rates for 2018 compared to 2017. In addition, CMS makes changes to its policies implementing the site-neutral provisions that requir Read More . . .

CMS Announces Medicare Premiums, Deductibles for CY 2018

11/30/2017

Adding to the list of calendar year 2018 Medicare program updates announced this month, the Centers for Medicare & Medicaid Services announced its Medicare Part A deductible for inpatient hospital services will increase by $24 in calendar year 2018, to $1,340. The Part A daily coinsurance amounts will be $335 for days 61-90 of h Read More . . .

ODM Updates 340B ‘SE’ Modifier Implementation Date for Hospital 340B Entities

11/30/2017

The Ohio Department of Medicaid’s policy team announced in a notification to OHA on Nov. 7 that all 340B entities that bill on a hospital outpatient UB04 will be required to bill an SE modifier on all 340B drug lines provided in an outpatient setting beginning Jan. 1, 2018, a delay from the requirement that was stated to Read More . . .

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