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


Final 30-Day Window Opens for Changes to SFY 2016 Cost Reports


The final 30-day window for all hospitals to change their cost report data has opened and will close Tuesday, May 30. To make changes during this period, each hospital will have to pay a “cover charge” equal 0.03 percent of its adjusted total facility costs.   Once this 30-day window closes, all SFY 2016 cost repo Read More . . .

Archive Copy of April 26 Webinar on EAPG Implementation


An archive recording of the April 26 OHA Health Economics & Policy webinar Preparing for a Successful EAPG Implementation is available here.  A copy of the PowerPoint is here.  Read More . . .

CMS Proposes 2018 Payment, Policy Updates for Medicare Hospital Admissions, Releases a Request for Information


CMS issued a proposed rule on April 14 to update 2018 Medicare payment and policies when patients are admitted to hospitals. CMS states the proposed rule aims to relieve regulatory burdens for providers; supports the patient-doctor relationship in health care; and promotes transparency, flexibility, and innovation in the delivery of Read More . . .

2011 DSH Audit Recoupment


Ohio Department of Medicaid on April 24 mailed recoupment letters to hospitals with dollars to be recouped according to the 2011 DSH Audit prepared by Myers and Stauffer. A sample letter can be found here. The letters were only sent to hospitals affected by this recoupment, so most will not receive a letter. If your hospital is one Read More . . .

ODM Releases Final Hospital Base Rates, EAPG Relative Weights, APRDRG Weights for July 1


The Ohio Department of Medicaid has released the Hospital Base Rates, EAPG Relative Weights and APRDRG Weights for July 1, 2017. These have been vetted by ODM and the Medicaid managed care plans and are now ready for release. Please note that the relative weight table includes Average Length of Stay. The final document detailing all Read More . . .

ODM Finishes Review of SFY 2016 Cost Reports


The Ohio Department of Medicaid completed review of all in-state DRG and DRG-exempt hospital cost reports for SFY 2016, excluding psychiatric hospitals. Four hospitals with costs reports uploaded to the MITS portal March 28 l have their 30-day window close April 28. After this, the final 30-day window will open for all hospitals and Read More . . .

Magazine Presents Former OHA Finance Leader with Lifetime Achievement Award


Columbus CEO magazine on March 23 presented former OHA Vice President of Health Economics & Policy Charles Cataline with the 2017 Healthcare Lifetime Achievement Award at the fifth-annual Central Ohio Healthcare Achievement Awards dinner.   Cataline retired from OHA in December 2016 after 36 years with the Association. He Read More . . .

U.S. House Leadership Cancels Vote on ACA Repeal Bill


U.S. House Republican leaders last week canceled the planned vote on the American Health Care Act (H.R. 1628), legislation to repeal and replace parts of the Affordable Care Act.   The prospects of future congressional action addressing the ACA are uncertain at this time.   The AHCA had been the subject of much debate Read More . . .

Hospital Executives Testify to HHS Finance Subcommittee Against State Budget Cuts, Non-Contracting Language


A panel of health care executives testified Wednesday before the Ohio House Finance Subcommittee on Health and Human Services against hospital payment cuts and non-contracting language proposed in House Bill 49, the 2018-2019 state operating budget.   The panel included member hospital executives Ray Chorey, president, Southe Read More . . .

First Round of ADRs Distributed


Performant Recovery, the recovery audit contractor, on March 23 sent the first round of ADRs to hospitals.   Performant Recovery, recently was awarded the RAC contract for Region One: Michigan and Indiana (J8 WPS MAC jurisdiction), Ohio and Kentucky (J15 CGS MAC jurisdiction) and New York, Vermont, New Hampshire, Maine, Massa Read More . . .

Medicaid Requirements for 340B Covered Entities Delayed


The Ohio Department of Medicaid on March 6 withdrew rule 5160-1-17.11, Requirements for 340B Covered Entities. In part, the rule required covered entities to include modifiers on outpatient claims with 340B drug lines where the hospital was seeking reimbursement for the drug provided. The rule also set ODM’s status reporting r Read More . . .

CMS Delays Series of Program Implementation Dates


The Centers for Medicare & Medicaid Services delayed implementation dates from July 1 to Oct. 1 for a group of Medicare programs, including: Advancing Care Coordination Through Episode Payment Models; Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model.   Addit Read More . . .

CareSource Updates OHA and Large Provider Group on NCD/LCD Claim Edits, Claims Recoupments and Reprocessing, Provider Credentialing Delays and System Enhancements


CareSource Vice President of the Ohio Market Operations Dan Hounchell yesterday reported to OHA’s Admitting, Billing and Collection Committee and Large Provider Group that CareSource is committed to work on resolving outstanding payment recoupment issues, edit and denial challenges and unlinked/undocumented medical policies. O Read More . . .

OHA Health Economics & Policy Webinar: Best Practice in Audit Response


An archive recording of the March 14 OHA Health Economics & Policy webinar Best Practice in Audit Response is available here.  A copy of the PowerPoint is here and a copy of Bluemark’s esMD program handout is available here.  contact Shawn Stack with questions. Read More . . .

March 9 Behavioral Health Redesign Webinar


A recording of the March 9 webinar on Behavioral Health Redesign is available here. A copy of the slides is available here. Contact Aly DeAngelo with any questions.  Read More . . .

CMS Posts MOON FAQs Online


The CMS has posted frequently asked questions concerning the Medicare Outpatient Observation Notice (MOON).  The “MOON FAQs” are available on the CMS website.    High level directives are offered on how hospitals should be completing the free-text fields on the form specifically to the field stating   Read More . . .

The Department of Veterans Affairs Presents Helpful Reference Materials


The Department of Veterans Affairs presented helpful resource materials to hospitals last month at the Feb. HFMA/AAHAM Conference in Akron, Ohio. The Ohio Hospital Association has posted the following VA reference materials to our website for easy access and review: VA Rejection/Denial Reasons with Definitions VA Appeal Read More . . .

CMS Social Security Number (SSN) Removal Initiative


The Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, requires CMS to remove Social Security Numbers from all Medicare cards by April 2019 and CMS will respond with randomly generated Medicare Beneficiary Identifiers, starting this spring. Medicare identifiers will replace the Health Insurance Claim Number on Medicare Read More . . .

Performant Recovery has been Granted Permission to begin sending ADR’s by CMS.


The Recovery Audit Contractor (RAC) has stated that they will be tying up a few loose ends on their side and will then begin activity in the next few weeks.   Performant Recovery, with locations in Livermore, CA and San Angelo, TX, was awarded the recent RAC Contract for Region One: Michigan and Indiana (J8 WPS MAC jurisdicti Read More . . .

Medicaid Requirements for 340B Covered Entities (5160-1-17.11) - Withdrawn


The Ohio Department of Medicaid withdrew rule 5160-1-17.11, “Requirements for 340B Covered Entities” on March 6, 29017 which in part required covered entities to include modifiers on OP claims with 340B drug lines where the hospital was seeking reimbursement for the drug provided. The rule also set forth ODM’s stat Read More . . .

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