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 Provides Work Around for Synagis billing


The Ohio Department of Medicaid on Feb. 14 informed OHA of a work around hospitals can use to bill Synagis, the high-cost drug prescribed to children being treated to prevent respiratory syncytial virus infection.   While ODM researches an issue with 3M causing this treatment to be underpaid, the department requests that hosp Read More . . .

Save the Date for OHA’s 2019 Annual Meeting


Employees of OHA member hospitals and corporate partners are invited to attend the 2019 OHA Annual Meeting June 3-5 in Columbus. The three-day event features more than 60 educational sessions and is a premier opportunity for health care providers and administrators at all levels to gain valuable insight about statewide industry Read More . . .

CMS Issues Clarification on Informational 'ER' Modifier


Effective Jan. 1, as documented in the 2019 OPPS Final Rule, CMS requires that the HCPCS modifier "ER" be reported "on every claim item for outpatient hospital items and services furnished in an off-campus provider-based emergency department," with the exception of critical access hospitals.   To add clari Read More . . .

2018 OHA Lobbying Expenditure Letter Available


In accordance with federal tax law, the Internal Revenue Service requires hospitals and other facilities to apportion trade association dues related to lobbying expenses. The 2018 Lobbying Expenditure Letter is available here. For questions, contact Erin Biles, director of Accounting, at  Read More . . .

Fourth and Final 2018 HCAP Distribution Sent


ODM has distributed the remaining funds for 2018 HCAP with a fourth distribution Feb. 11. Just after the third distribution,  the one outstanding assessment was paid to generate the fourth distribution. Please contact Daniel Vielhaber with questions or concerns. Read More . . .

CareSource Shares Provider Onboarding, Claim Appeals Education


CareSource has shared with OHA materials the managed care payer presented recently to FQHC’s on CareSource’s provider onboarding and claim appeals processes.   CareSource recently had a conversation with OHA and one of our member hospitals regarding the onboarding process and felt other hospital providers may Read More . . .

Ohio Hospitals' Annual Registration Reports Due March 1


There is no hospital  licensure in Ohio, however hospitals must be registered and must report certain information to the Ohio Department of Health annually in accordance with section 3701.07  of the Ohio Revised Code. The rules set forth in Chapter 3701-59 of the Ohio Administrative Code establish the specific re Read More . . .

2019 Federal Poverty Guidelines Released


The U.S. Department of Health and Human Services poverty guidelines for 2019 have been released and are effective as of Jan. 11. Publication of the Federal Register notice is delayed due to the federal government shutdown. The guidelines can be found here. Read More . . .

Third HCAP Distribution Coming Jan. 28


At the time of the second 2018 HCAP distribution there were two hospitals with outstanding assessments, resulting in a decreased second distribution for all hospitals. As a consequence of one of those assessments being paid, there will be a third distribution for 2018 HCAP on Jan. 28. The hospital-specific distributions can be found Read More . . .

Attend Ohio BWC’s Medical & Health Symposium April 26 – 27; it’s free!


BWC invites you and your staff to the fourth annual Ohio Workers’ Compensation Medical & Health Symposium. Based on your request for Friday and Saturday dates, it will be April 26 to April 27, at the Greater Columbus Convention Center. Online registration opens in February.   You and your staff can participate in a Read More . . .

Ohio BWC Offers Free Educational Webinars to Providers


BWC invites hospital staff members to participate in the following educational webinars that support providers in their treatment of Ohio’s Injured workers. Join BWC’s medical policy unit for webinars on topics about billing and reimbursement policy, coverage and service provision. Registration is required for each live Read More . . .

Ohio Medicaid Updates Operational Issues to Hospitals at the Large Provider Group


The Ohio Department of Medicaid on Jan. 18 provided its quarterly update to Ohio hospitals regarding operational issues. ODM’s key updates included:EAPG issues and fixesFor Observation adjustments where the second day of observation was packaging for $0.00 payment or discounting 50 percent payment from July 1, 2018 – Nov Read More . . .

Ohio Medicaid Publishes General Policy Updates


The Ohio Department of Medicaid on Jan. 18 provided a quarterly general policy update to Ohio hospitals. ODM’s key policy updates included:Annual HCPCS/CPT Code UpdatesODM is working on their system update to include all new covered HCPCS and CPT Codes for 2019 and will have the codes built into their grouper by Feb. 14.Additi Read More . . .

340B Case Continues, AHA Outlines Medicare Appeals Instructions for Hospitals


U.S. District Court for the District of Columbia on Dec. 27 issued an order in favor of the American Hospital Association and the other plaintiffs in the lawsuit to stop the Centers for Medicare & Medicaid Services' nearly 30 percent reduction in the reimbursement rate for 340B drugs as exceeding the statutory authority of t Read More . . .

OHA’s Admitting, Billing & Collection Committee Meets with CareSource on Operational Updates


CareSource leadership on Jan. 16 provided updates to OHA’s Admitting, Billing & Collection Committee on a list of outstanding issues OHA has been monitoring and pushing for resolution on with the Medicaid managed care payer. Following the plan’s status update to committee members, OHA and the committee reviewed addi Read More . . .

Archive Copy: Jan. 15 Ohio Medicaid Updates for 2019: Fee-for-Service & Managed Care Webinar.


On Jan. 15, OHA’s Health Economics & Policy team and corporate partner BKD hosted a webinar, "Ohio Medicaid Updates for 2019: Fee-for-Service & Managed Care." An archive recording of the webinar is available here along with a copy of OHA’s and BKD’s presentation. Please contact Shawn Stack w Read More . . .

Archive Copy: Jan. 15 New Standard Authorization Forms Webinar


OHA on Jan. 15 hosted a webinar, "The Ohio Department of Medicaid’s New Standard Authorization Forms." An archive recording of the webinar is available here along with a copy of OHA’s presentation. The final rule and related appendices containing the Standard Authorization Forms are available here. Conta Read More . . .

Ohio Medicaid Fee-for-Service and Managed Care 2019 HCPCs/CPT Code Updates Status’


Every year, providers and payers alike are very busy updating diagnosis, CPT and HCPCS codes so services can be timely and appropriately billed and processed. OHA has reached out to Ohio Medicaid and the Medicaid Managed Care plans to provide the following update on their readiness to accept code changes:Fee for Service states that Read More . . .

CMS Activating Systematic Validation Edits for OPPS Providers with Multiple Service Locations


The Centers for Medicare & Medicaid Services  announced in October that the agency will be activating systematic validation edits  for the enforcement of requirements in the Medicare Claims Processing Manual, Chapter 1, and section 170 which describes Payment Bases for Institutional Claims. Providers should make c Read More . . .

2018 HCAP 2nd Distribution Reduction


Due to unpaid assessments from two hospitals, ODM has reduced the size of the second HCAP assessment which is set to be paid today, Jan. 14. In total, the reduction will be $695,311.19, which will wind up being a relatively modest reduction for individual hospitals receiving distributions. After the missing assessments are paid, ODM Read More . . .

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