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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


 

ODM Reports Defect Repaired in 3M EAPG Grouper Impacting Managed Care Plans

08/17/2017

The Ohio Department of Medicaid reported to the Ohio Hospital Association a programming fix is being released today to patch the 3M Grouper error causing manage care claims to be held. Optum will be performing tests on the updated grouper for the next three-weeks, then the plans will need one to two weeks to install the fix to their Read More . . .

CMS Cancels Episode, Cardiac Bundle Payment Models; Proposes Changes to Joint Replacement Model

08/16/2017

The Centers for Medicare & Medicaid Services reported Aug. 15 it will roll-back two bundled-payment models that were set to start on Jan. 1, 2018--the Advancing Care Coordination through Episode Payment Models and Cardiac Rehabilitation Incentive Payment Models. CMS also announced it will scale back the number of mandatory geogr Read More . . .

Medicare Outpatient Prospective Payment System Proposed Rule for CY 2018 OHA Impact Analysis

08/11/2017

The proposed calendar year 2018 payment rule for the Medicare Outpatient Prospective Payment System (OPPS) was published in the July 20, 2017 Federal Register. The proposed rule includes annual updates to the Medicare fee-for-service outpatient payment rates as well as proposed regulations that implement new policies, among other re Read More . . .

Ohio Hospitals Inquire on CareSource Claims, Policy, Communication Initiatives that Continue to Pend Unresolved

08/11/2017

Shawn Stack, director of Health Economics & Policy for the Ohio Hospital Association held a conference call with CareSource vice president of Ohio Market Operations Dan Hounchell to discuss CareSource’s continued commitment to address claims processing issues, policy development and communication breakdowns with hospital p Read More . . .

CMS Announces 2018 Meaningful Use Data Submission Update

08/09/2017

The Centers for Medicare & Medicaid Services announced Aug. 8 that hospitals and critical access hospitals participating in Medicare’s Electronic Health Record Incentive Program will begin submitting their meaningful use data via the QualityNet Secure Portal instead of through the Medicare and Medicaid EHR Incentive Progra Read More . . .

Ohio’s Medicaid Open Enrollment Continues through Nov. 30

08/09/2017

Medicaid recipients may change Medicaid plans by calling 1-800-324-8680 or visit the Ohio Medicaid consumer hotline website.   Read More . . .

OHA Advocates Holding Hospital Rates, ODM to Track Medicaid Spending

08/09/2017

OHA was successful during state budget negotiations to secure a hospital Medicaid rate freeze in the Ohio House and Senate —an unprecedented act to preserve hospital rates in statute—yet Gov. John Kasich on June 30 vetoed this provision of Amended Substitute House Bill 49 (the final budget). As a result, the Ohio Departm Read More . . .

Registration Open for OHA’s Annual Medicare, Medicaid Event

08/09/2017

Medicare and Medicaid in 2018, also know as the annual OHA Larry and Larry Show, is scheduled for Thursday, Sept. 14. The meeting agenda and registration information are available on OHA’s event page.  The event is designed to update hospitals, health care providers and organizations on fed Read More . . .

CGS Updates Medical Review Article on Spinal Injections

08/09/2017

CGS Administrators, LLC on July 27 issued a correction to its May 22 article on the discontinuation of complex medical reviews related to spinal injections. The article had previously stated the incorrect related CPT code in the article that was to be discontinued in the complex medical review. The revised article can now be viewe Read More . . .

CMS 2017 Quality Payment Hardship Exception Application Live

08/09/2017

The Quality Payment Program Hardship Exception Application for the 2017 transition year opened on Aug. 2. Clinicians may also contact the Quality Payment Program Service Center and work with a representative to verbally submit an application. Applications are subject to annual renewal.   To streamline the process, the applica Read More . . .

Ohio’s Price Transparency Law – Update

07/31/2017

Despite OHA’s best efforts to resolve the price transparency issue during the state budget process, the the existing price transparency law that is the subject of OHA’s lawsuit remains in place. The court order preventing the law from going into effect still stands. OHA is preparing for a hearing currently scheduled Read More . . .

3 Changes Hospitals May Need to Make for New Medicare Cards with New Numbers

07/31/2017

The Medicare Access and CHIP Reauthorization Act of 2015 requires CMS to remove Social Security numbers from all Medicare cards by April 2019. CMS will begin mailing new Medicare cards with a new Medicare number (currently called the Medicare Claim Number on cards) to your patients in April 2018. Hospitals may need to change systems Read More . . .

Important Medicaid EHR Incentive Program Information Released

07/31/2017

The U.S. Department of Health and Human Services Office of Inspector General in August 2016 issued an audit report finding that Ohio’s Medicaid Provider Incentive Program, or MPIP, made incorrect Medicaid electronic health record incentive payments to hospitals totaling $526,000, based on its review of a sample size Read More . . .

Hospitals Report Success in Using ODMs Medicaid Provider Complaint Spreadsheet Process

07/31/2017

Hospitals reported to OHA in July that the new process is yielding positive results in resolving claim and payment issues with the Medicaid managed care plans! OHA  worked with the Ohio Department of Medicaid’s Bureau of Managed Health Care to develop a user friendly provider complaint form spreadsheet. The Provider Comp Read More . . .

Ohio BWC Proposed State-Fund Hospital Payment Plan for CY 2018

07/31/2017

The Ohio Bureau of Workers Compensation this month met with OHA to discuss its proposed 2018 updates to its inpatient hospital prospective payment system, or IPPS. Modeled on CMS’ Medicare IPPS, the BWC version uses most of the same MS-DRG grouper and pricer components, but adjusts each resulting Medicare payment by a BWC Read More . . .

OHA Continues to Discuss Claims, Policy, Communication Issues with CareSource

07/31/2017

OHA held a conference call with CareSource Vice President of Ohio Market Operations Dan Hounchell on July 24 to follow up on CareSource’s progress in addressing claims processing issues, policy development and communication breakdowns with hospital providers throughout Ohio. On the call, CareSource provided OHA with updates to Read More . . .

Medicare OPPS Proposed Rule for 2018 Released for Comment

07/31/2017

The proposed calendar year 2018 payment rule for the Medicare Outpatient Prospective Payment System was published in the July 20 Federal Register. The proposed rule includes annual updates to the Medicare fee-for-service outpatient payment rates as well as proposed regulations that implement new policies, among other regular up Read More . . .

ODM Sets Timeline for Behavioral Health Redesign Implementation

07/28/2017

Ohio’s Behavioral Health Redesign did not go into effect on July 1, in deference to the legislative budget process. The Ohio Department of Medicaid and the Ohio Department of Mental Health and Addiction Services are providing the following updated information for behavioral health redesign implementation resulting from the fin Read More . . .

ODM Announces 340B Modifier Implementation Date for Hospital 340B Entities

07/28/2017

The Ohio Department of Medicaid’s policy team announced on July 27 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 Oct. 1. OHA announced to the membership on May 9 that the requirement would be forthc Read More . . .

ODM Announces July 31 IMD Webinar

07/28/2017

The Ohio Department of Medicaid announced this week that it will host an IMD Webinar from 1:30 to 3 p.m. July 31. Hospitals and  providers can register here.   Effective July 1, in accordance with 42 CFR 438.6, Medicaid managed care plans can pay for inpatient IMD stays for up to 15 days in a calendar month for indi Read More . . .

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