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Finance News

The latest news and updates on federal and state hospital and health system reimbursement policies and procedures.

View OHA's monthly finance alert wrap up - By the Numbers
 

Call to Action: Pledge Support of 340B Stewardship Principles

10/22/2018

Leaders from the American Hospital Association and the AHA Advocacy Alliance for the 340B Drug Pricing Program have announced new principles for ensuring good stewardship of the 340B program and request member hospitals pledge to join the effort. This new AHA-led initiative aims to strengthen the 340B program by increasing transpar Read More . . .

UPDATE: ODM Addressing Inappropriate Denials for Invalid NDC/HCPCS

10/15/2018

The Ohio Department of Medicaid’s Hospital Policy Team reported to OHA that, due to an oversight, edit 4891, Invalid NDC/HCPCS combination, was returned to a deny status effective Oct. 1. ODM is planning an emergency update to have the denials returned to pay/post status prior to that date.ODM confirmed on Oct. 15 that the eme Read More . . .

Medicare Enrollment Opens Today

10/15/2018

Open enrollment for Medicare runs Oct. 15 through Dec. 7. For consumers who choose a new Medicare Advantage or Part D plan, that new coverage will begin on Jan. 1, 2019. Here is a helpful consumer site if hospitals need reference materials for staff training. Please contact Shawn Stack with questions. Read More . . .

New Medicare Card Mailing Update — Ohio in Current Wave

10/15/2018

CMS several weeks ago started mailing new Medicare cards to people with Medicare who live in Wave 7 states and territories including: Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Puerto Rico, Tennessee and the Virgin Islands. CMS concluded mailing cards to people with Medicare who live in states within Waves 1 throug Read More . . .

CMS Reports Exchange Premiums Drop for 2019

10/12/2018

The Center for Medicare & Medicaid Services on Oct. 11 reported average premiums for silver plans dropped 1.5 percent for 2019, the first-time premiums have fallen since the implementation of the Exchange Plans in 2014.   The full CMS announcement can be accessed here. Read More . . .

ODM Mails Hospital Franchise Fee Assessment Letters

10/12/2018

ODM has mailed the Hospital Franchise Fee assessment letters to providers. A sample letter can be found here. If you do not receive your letter by mid-October, please contact ODM as soon as possible. The first franchise fee assessment will be due to ODM on Oct. 29. The subsequent UPL payment will be paid to providers on Nov. 12. P Read More . . .

OHA President Expresses Concerns About Site-Neutral Policies, AHA Launches Ad Campaign

10/12/2018

OHA President and CEO Mike Abrams in a letter to the editor on Oct. 12 detailed the hospital community’s concern about the Centers for Medicare & Medicaid Services' proposal to expand certain payment policies in 2019 that could harm access to care, particularly for the most vulnerable, by cutting $51 million Read More . . .

Archive Copy: Oct. 9 Ohio Medicaid’s Outpatient EAPG Grouper; A One Year Recap Webinar

10/10/2018

OHA’s Health Economics & Policy team on Oct. 9 hosted a webinar, "Ohio Medicaid’s Outpatient EAPG Grouper; A One Year Recap." An archive recording of the webinar is available here along with a copy of BKD’s presentation. Please contact Shawn.Stack@ohiohospitals.org with questions.    Read More . . .

CMS Publishes CHIP Provisions

10/08/2018

CMS on Oct. 5 published a summary of key provisions of the HEALTHY KIDS and ACCESS Acts that are related to the Children’s Health Insurance Program, or CHIP, as well as other children’s  coverage and quality provisions. Congress in March extended funding for CHIP through Sept. 30, 2027.   Included are details Read More . . .

CMS Releases FAQ on New Transparency Requirement

10/04/2018

The Centers for Medicare & Medicaid Services recently expanded on new health care price transparency requirements for hospitals in a series of frequently asked questions (FAQs) published on its website. The FAQs cover which hospitals are subject to the new requirements, the definition of machine-readable, and what items and ser Read More . . .

ODM Announces SFY 2019 Hospital Franchise Fee, UPL Payment Schedules

10/04/2018

The Ohio Department of Medicaid has set dates for hospital assessments and supplemental Medicaid upper payment limit, or UPL, payments for SFY 2019: 1st Assessment: Oct. 29 1st Payment: Nov. 12 2nd Assessment: Jan. 14, 2019 2nd Payment: Jan. 28, 2019 3rd Assessment: Feb. 25, 2019 3rd Payment: March 11, 2019 4th Assessment: Ap Read More . . .

ODM Reports Inappropriate Denials for Invalid NDC/HCPCS

10/02/2018

Ohio Department of Medicaid’s Hospital Policy Team updated OHA that, due to an oversight, edit 4891, Invalid NDC/HCPCS combination, was returned to a deny status effective Oct. 1. ODM is planning an emergency update to have the denials returned to pay/post status prior to that date. However, the more likely scenario is that i 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 . . .

Webinar Available on 2016 DSH Audit

09/26/2018

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 Read More . . .

Provider Update: Early Issues with New Medicare Cards

09/25/2018

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.PLEASEINFORM YOUR MEDICARE PATIENTS when speaking with them regarding appointments and scheduling Read More . . .

OHA Comments on CY 2019 Outpatient Prospective Payment System Fee Schedule Proposed Rule

09/25/2018

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 . . .

CareSource Provides Operational Updates to OHA and LPG

09/24/2018

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 co Read More . . .

Register for OHA’s Deep Dive Into Medicaid EAPGs Webinar

09/21/2018

Join the Ohio Hospital Association and Corporate Partner BKD for a Deep Dive into Ohio Medicaid EAPGs and Lessons Learned Over the Past Year at 10 a.m. Oct. 9.The webinar is free to OHA members. OHA recommends this session for hospital professionals in patient access, finance, billing modeling and payment analysts.After registe Read More . . .

Ohio Medicaid Provides Hospitals with Claim Correction Updates

09/21/2018

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 that Read More . . .

340B Suit Refiled in Federal Court

09/20/2018

The American Hospital Association, Association of American Medical Colleges, America’s Essential Hospitals and three hospital plaintiffs on Sept. 5 refiled a lawsuit in federal district court seeking expedited relief from Medicare payment cuts for many hospitals in the 340B Drug Pricing Program. An appeals court in July delaye Read More . . .

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