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 Fee-for-Service Advisory Notice on ERA Dated Nov. 9


The Ohio Hospital Association has been following up with Ohio Department of Medicaid’s Hospital Policy Team this week on the credit balances that were posted to Ohio Medicaid’s Nov. 9 remit, creating large credit balances for many hospitals.  ODM released the following notice this afternoon regarding that remit aft Read More . . .

OHA Publishes Overview of the Ohio Medicaid Hospital EAPG & Biennium Budget Update and Monitoring Resources


An archive recording of the Nov. 9 OHA Health Economics & Policy webinar "Overview of the Ohio Medicaid Hospital EAPG & Biennium Budget Update and Monitoring” is available here. A copy of the PowerPoint is available here. Read More . . .

OHA Publishes BWC’s Proposed 2018 OPPS Rule Resources


An archive recording of the Nov. 2 OHA Health Economics & Policy webinar "Overview of the Bureau of Workers’ Compensation’s Proposed 2018 OPPS Rule and A Hospital Guide to Unraveling Complex Workers’ Compensation Cases and ICD-10” is available here. A copy of the PowerPoint is available here.   Read More . . .

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


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 . . .

CMS Extends Deadline to Amend Worksheet S-10 Reporting


CMS has extended the window from Oct. 31 to Jan. 2, 2018 for hospitals to amend uncompensated care, bad debt and other Worksheet S-10 reporting on their fiscal year 2014 and 2015 Medicare cost reports.Proper reporting of S-10 data is critical, as it is now used for the distribution of the vast majority of Medicar Read More . . .

Overview of Ohio Medicaid 2018 Update for Hospital Self-Pay, Eligibility Materials Published


An archive recording of the Oct. 24 OHA Health Economics & Policy webinar "Ohio Medicaid 2018 Update for Hospital Self-Pay, Eligibility” is available here. A copy of the PowerPoint is available here. Read More . . .

Register for Ohio Bureau of Workers’ Compensation 2018 OPPS Webinar


OHA’s Nov. 2 Health Economics & Policy Webinar will cover a review of Ohio Bureau of Workers’ Compensation’s proposed 2018 hospital outpatient reimbursement and polices, as well as best practices in BWC billing and coding.  The webinar is free to OHA Members. Click here to register.  Read More . . .

Register for OHA’s Medicaid EAPG Update, Monitoring Partnership Webinar


Join the Ohio Hospital Association and BKD at 10 a.m. Nov. 9 for a deep dive into the Medicaid EAPG and biennium budget monitoring project.  The webinar is free to OHA members. Click here to register. After registering, you will receive a confirmation email containing information about joining the webinar. A record Read More . . .

ODM Releases Revised SFY 2018 UPL Payment Schedule


A revised UPL distribution schedule has been released and can be found here. ODM is prepared to pay one quarter of the annual payments reflected on the revised schedule, and hospitals can expect to receive that first quarterly UPL payment early next week. The revisions in this latest schedule were driven by data corrections and corr Read More . . .

Overview of KEPRO: ODM Retrospective Claims Review Webinar Materials Published


An archive recording of the Oct. 10 OHA Health Economics & Policy webinar "KEPRO: ODM Retrospective Claims Review Webinar" is available here. A copy of the PowerPoint is available here. A copy of the Q&A document is available here.   Read More . . .

ODM Rate Cut Rule Filed


As expected, the Ohio Department of Medicaid yesterday filed the rule implementing a 5 percent hospital rate cut.   See the rule, the public notice, and other documents here.   Note that the public hearing and deadline for written comments is Nov. 17. OHA plans to oppose this rule.   OHA will be in touch with mo Read More . . .

OHA Releases Patient Education Letter Template In Response to Anthem’s Radiologic Policies


The Ohio Hospital Association today released a patient communication template hospitals can use to communicate with patients impacted by Anthem BCBS’s new outpatient radiologic policy implemented in Ohio on Sept. 1.   The template  assists hospitals in explaining the benefits patients may want to consider when Read More . . .

OHA Releases Preliminary Hospital-Specific 2018 UPL Payment Data


OHA has posted the projected 2018 Upper Payment Limit amounts due to hospitals here. UPLs were calculated in this preliminary run to be $488.3 million statewide, which is $50 million (or 9.3 percent) lower than SFY 2017 payments. Most hospitals will see a decline due to continued erosion of traditional Medicaid fee-for-service volu Read More . . .

Slides from Sept. 21 Episode Based Payment Webinar


ODM hosted its monthly Episode Based Payment Webinar on Sept. 21. The slides for that webinar can be found here. The next SIM Episode Based Payment webinar will be 10 a.m. Thursday, Oct. 19. Please contact Aly DeAngelo with any questions. Read More . . .

Don't Miss Medicare’s Open Enrollment Period Oct. 15 – Dec. 7


Medicare health and drug plans can make changes each year on cost, coverage, network providers and pharmacies. All enrollees in Medicare can change their health plans and prescription drug coverage for 2018 to better meet their personal needs between Oct. 15 to Dec. 7.Please make certain hospital registration staff are aware of this Read More . . .

CMS Quality Payment Program Fall Series Begins


If you are affiliated with a hospital or provider and interested in learning more about the Quality Payment Program, the Centers for Medicare & Medicaid Services fall educational series has started. For general QPP information, click here. CMS fall educational schedule:  QPP MIPS: Pick your PACE - 1 p.m. (CT) Sept. 2 Read More . . .

CareSource Shows Good-Faith In Resolving Claims Issues


Ohio Hospital Association representatives met with CareSource’s Ohio president, vice president of Ohio Market Operations and Ohio Government Affairs director Oct. 3 in Columbus to talk through CareSource’s plan to address communication and claims issues that have been impacting payments and taxing administrative resource Read More . . .

OHA Meeting with State Leaders on 2 Critical Medicaid Payment Issues


The Ohio Hospital Association, along with other provider associations, met Thursday with the directors of the Governor's Office of Health Transformation and the Ohio Department of Medicaid as well as a representative from the Governor's office to hear updates on plans to move forward on two issues of key importance to the ho Read More . . .

CMS Issues Instructions for Worksheet S-10


CMS issued new and revised instructions for charity care and bad debt data reported by hospitals on worksheet S-10 of the Medicare Cost Report.This data is now used for the distribution of Medicare Disproportionate Share Hospital, or DSH, funding. See this Medicare Learning Network (MLN) document from CMS, intended to hel Read More . . .

Ohio AG Office Begins Reimbursement for HIV Prophylaxis Under SAFE Program


The Ohio Attorney General’s Office on Oct. 3 began reimbursing for HIV Prophylaxis as part of the Sexual Assault Forensic Exam Program. In July 2017, the Ohio legislature approved language within the SAFE statute to add payment for HIV prophylaxis when directly related to a sexual assault and done in conjunction with forensic Read More . . .

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