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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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CMS Proposes Updates to CY 2019 Hospital Outpatient Prospective Payment System

07/31/2018

The Centers for Medicare & Medicaid Services on July 25 issued a proposal to update the calendar year 2019 hospital outpatient prospective payment system rates by 1.25 over CY 2018 rates. The agency’s release also includes site-neutral payment policy changes that would reduce the payment rate for hospital outpatient clinic Read More . . .

Proposed CY 2019 CMS Updates Released for Physician Fee Schedule, Revisions to Part B

07/31/2018

CMS on July 12 issued a proposal to update physician fee schedule rates by 0.25 percent in calendar year 2019. The impact of the proposed update and the budget-neutrality adjustment required by law yields a proposed 2019 PFS conversion factor of $36.05, an increase of $.06 over last year. The rule also proposes to reduce payment for Read More . . .

CMS Proposes CY 2019 Home Health Update and CY 2020 Redesign

07/31/2018

CMS on July 2 released the home health prospective payment system proposed rule for calendar year 2019, which also proposes a major redesign for CY 2020. CMS will accept comments on the proposed rule through Aug. 31. Please contact Shawn Stack with questions. Read More . . .

Medicare Debuts myCGS Dashboard for Providers to Track Medical Review Requests

07/31/2018

Ohio’s Medicare Administrative Contractor, CGS, has launched the myCGS MR Dashboard for providers to quickly identify medical review additional document requests, or ADRs, sent to the hospital. Medical Review, or MR, department staff occasionally needs additional documentation from providers in order to process claims.  Read More . . .

CMS Updates Deadline for MIPS Review Requests

07/31/2018

The Centers for Medicare & Medicaid services recently announced the deadline for submitting a MIPS Targeted Review Request is now Oct. 1. If providers participated in the Merit-based Incentive Payment System, or MIPS, in 2017, their MIPS final score and performance feedback is now available for review on the Quality Payment Read More . . .

CMS Distribution of Ohioans' New Medicare Cards Under Way

07/31/2018

Ohioans covered by Medicare should begin receiving their new Medicare cards as waive 7 of CMS’ rollout of the new identification cards began this month. New Medicare cards are being sent out nationwide through April 2019 to replace existing Health Insurance Claim Numbers, or HICNs. CMS on July 11 published MLN Matters 10425 pr Read More . . .

CMS to Allow Participants to Withdraw from Bundled Payment Model in March

07/31/2018

CMS announced July 6 that it will allow participants in the Bundled Payments for Care Improvement Advanced model to retroactively withdraw all or some episode initiators and clinical episodes from the model in March 2019. This decision was announced after the agency began uploading new preliminary target prices and claims data Read More . . .

ODM Updates Hospital Billing Guidelines

07/31/2018

The Ohio Hospital Association’s Health Economics & Policy team recommends member hospitals review the New Medicaid Hospital Guidelines for claims with dates of discharge and dates of service on or after July 1, 2018.   The most recent updates include clarification on the following items:   Instance in which M Read More . . .

CareSource Provides Operational Updates to OHA

07/31/2018

CareSource leadership on July 18 provided updates on a comprehensive list of outstanding issues OHA has been working on with Ohio’s largest Medicaid managed care payer. The core issues include claim processing breakdowns, covered service discrepancies, inappropriate denials, authorization issues surrounding medical treatment a Read More . . .

OHA Reminds Hospitals of Medicaid Reimbursement for Private Rooms

07/31/2018

Ohio Medicaid allows reimbursement for private rooms under specific conditions, yet OHA has learned many providers are not seeking reimbursement. To avoid lost revenue, services must be billed under the following conditions:   When a private room is medically necessaryWhen a hospital has no semi-private roomWhen the patient c Read More . . .

State Promotes Parity as Behavioral Services Shift to Managed Care

07/31/2018

The Ohio departments of Medicaid and of Mental Health and Addiction Services on July 1 released a report examining compliance by managed care plans in providing parity in patients' access to those services. With the July 1 carve-in of behavioral health services in Medicaid into managed care, the state says it is now compliant wi Read More . . .

ODM Announces Downtime to OBWP County Portal, Deemed Newborn/PE Portal

07/31/2018

Ohio Department of Medicaid on June 1 announced providers will experience downtimes to the OBWP and Presumptive and Deemed Eligibility Portal due to system upgrades to incorporate cash and food assistance status into beneficiaries' records. Providers will experience downtimes Aug. 22 @ 6 p.m. – Aug. 28 @ 8 a.m. Read More . . .

Just the Facts - July 2018

07/31/2018

The preliminary 2018 HCAP model has been updated and an Excel spreadsheet of the updated model can be found here. This update differs from the June model in the following ways: The program size has decreased as the official federal allotment is now known.The close date for Good Samaritan Hospital (Dayton) has been upda Read More . . .

Hold the Dates - July 2018

07/31/2018

The “OHA Annual Medicare & Medicaid in 2019” event is scheduled for Sept. 20 at the Marriott Airport Columbus. Agenda and registration details will be forthcoming in two weeks, stay tuned!   Save Tuesday, Aug. 14 from 10 a.m. to noon for OHA’s Health Economics & Policy Webinar on KEPRO Retrospectiv Read More . . .

OHA Comments on FY 2019 IPPS Proposed Rule

06/29/2018

The Ohio Hospital Association on June 25 submitted comments on the Centers for Medicare & Medicaid Services' inpatient prospective payment system proposed rule for fiscal year 2019, offering recommendations with respect to Medicare Disproportionate Share Hospital, or DSH, payment, CAR T-cell therapy, the wage index, hospital Read More . . .

Register Now for the OHA, FHA Annual Medicare 101 Training

06/29/2018

The Ohio Hospital Association and Florida Hospital Association are teaming up again to present a comprehensive review of Medicare provider reimbursement systems and cost reporting July 26 in Columbus. The popular annual “Medicare 101” seminar is designed for trustees and hospital employees who are new to health care faci Read More . . .

Providers: Prepare for Ohioans with New Medicare Cards

06/29/2018

Ohioans covered by Medicare should begin receiving their new Medicare cards in July. New Medicare cards are being sent out nationwide through April 2019 to replace existing Health Insurance Claim Numbers, or HICNs. There is a 21-month transition period where providers will be able to use either the new Medicare Beneficiary Identifi Read More . . .

ICD-10 Rule for Non-Opioid Controlled Substances Effective July 1

06/29/2018

This has been a busy 12 months for new rules around opioid prescribing. The 5-day (minors) and 7-day (adults) rules for acute pain prescriptions were effective Aug. 31, 2017, and prescribers started adding the ICD-10 diagnosis code to all opioid prescriptions in December 2017. The second phase of the ICD-10 requirement, listing the Read More . . .

Ohio Medicaid Postpones Hospital Rate Cut

06/29/2018

The Ohio Department of Medicaid on May 31 confirmed to OHA that the department will be further postponing its proposed 5 percent rate cut and will not cut hospital rates for the remainder of calendar year 2018. The department also announced it would reduce the proposed inpatient recalibration and eliminate the outpatient recalibrati Read More . . .

Update: SFY 2018 Hospital Cost Report Posted

06/29/2018

The Ohio Department of Medicaid has posted the SFY 2018 Hospital Cost Report and instructions on its website. A link to download the files can be found here. The completed cost report must be postmarked on or before June 30 for hospitals filing with a cost reporting period ending between July 1, 2017 and Dec. 31, 2017. For hospital Read More . . .

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