New 2019 Rules, Private Payer Research Lead Agenda 

The OHA Admitting, Billing & Collection Committee met on Nov. 14, and the following topics were covered:
  • Ohio’s Medicare audit contractor, CGS, updated committee members on Medicare’s New Medicare Beneficiary Identifier, or MBI, rollout. Ohio Medicare enrollees are in Wave 7 of the national rollout. CMS released MLN Matters 10425 regarding details on the MBI initiative.
  • OHA staff updated committee members on OHA’s Medicare OPPS Brief for CY 2019 and BWC’s Proposed OPPS Rule for 2019.
  • CareSource provided updates and sought feedback from the committee on resolved and pending CareSource operational issues. The committee reported on five additional operational issues that CareSource will be researching over the next few weeks.
  • OHA staff sought feedback on the most recent OHA private payer work group payer scorecard from the committee and recruited members from the committee to join a small work group to focus on RARC and CARC mapping for scorecard.
The committee next meets via call on Dec.12 and will continue its work on issues of admitting, billing and collection importance to Ohio hospitals. For more information, please contact Shawn Stack.
 
  • CMS Approves HCAP for 2018; OHA, ODM Finalize Schedule
  • HCAP Model Updated
  • OIG Identifies Vulnerabilities in Hospital Wage Index
  • ODM Changes Utilization Review Vendor
  • New Restricted Coverage Rule Proposed
  • OHA Provides Toolkit for Complying with New Federal Rule on Posting Standard Charges
  • OHA Releases Brief on CMS Final CY 2019 OPPS Rule
  • CMS Publishes Final CY 2019 Physician Fee Schedule Rule
  • Online Tool Shows Costs for Common Surgical Procedures
  • OHA Reminds Members Location Addresses on Claims Must Match Medicare Records
  • New Medicare Card Mailing Update – Wave 6 Ends
  • UHC Announces Prior Authorization for Site of Care Outpatient MR/CT Services
  • VA Choice Program Expands Claims Contractor Role
  • Ohio BWC Proposes 2019 OPPS, ASC Rules
 

CMS Approves HCAP for 2018; OHA, ODM Finalize Schedule 

The Centers for Medicaid & Medicare Services on Nov. 20 approved the Ohio Department of Medicaid’s state plan amendment, governing the assessment and distribution formulas for HCAP in federal fiscal year 2018. OHA worked with ODM to finalize the schedule of assessments and payments, as follows:
  • HCAP letter sent to hospitals - Nov. 27
  • First assessment due - Dec. 11
  • First payment - Dec. 24
  • Second assessment due - Jan. 2, 2019
  • Second payment - Jan. 14, 2019
Contact Daniel Vielhaber with questions.

HCAP Model Updated 

There has been a small update to the 2018 HCAP model. Heather Hill Care Communities closed during the program year, and the model has been adjusted. Because this hospital was not going to receive a net gain, this will not substantially change the closed hospital or statewide residual pots. Data for the time when the hospital was closed was taken out of the model. Read more.

OIG Identifies Vulnerabilities in Hospital Wage Index 

The U.S. Department of Health and Human Services’ Office of Inspector General on Nov. 27 released a report identifying vulnerabilities in the hospital wage index system that impact Medicare payments to providers. Read more.

ODM Changes Utilization Review Vendor 

The Ohio Department of Medicaid has announced a new hospital utilization review vendor. Effective Dec. 1, HMS Permedion will assume responsibility for processing authorizations and pre-ceritfications. Pending Controlling Board approval, Permedion will assume utilization review duties Jan. 1, 2019. Read more.

New Restricted Coverage Rule Proposed

The Ohio Department of Medicaid on Nov. 1 proposed rule 5160:1-6-06.5 on how to calculate and apply a restricted Medicaid coverage period when an institutionalized individual improperly transferred an asset. Differences between this rule and the rule it is replacing are the addition of language regarding about how to calculate an initial pro-rated period of restricted coverage when a restricted Medicaid coverage period begins after the first day of the month and the treatment of new or newly discovered improperly transferred assets.

Contact Shawn Stack with questions.

OHA Provides Toolkit for Complying with New Federal Rule on Posting Standard Charges 

On Jan. 1, 2019 a new federal rule goes into effect that requires hospitals to post their “standard charges” on the hospital’s website in a “machine readable” format. OHA has prepared a toolkit for hospital members to assist in understanding the rule’s requirements and communicating with patients and the media about the chargemaster and related price transparency issues. Read more.

OHA Releases Brief on CMS Final CY 2019 OPPS Rule 

CMS on Nov. 2 published its final calendar year 2019 Medicare Outpatient Prospective Payment System rule update. The rule proposes to increase the OPPS Payment Rate +1.09 percent from the CY 2018 OPPS conversion factor.

OHA’s Payment Rule Brief can be found here.

Contact Shawn Stack with questions.

CMS Publishes Final CY 2019 Physician Fee Schedule Rule 

The Centers for Medicare & Medicaid Services on Nov. 1 issued its final rule updating calendar year 2019 Physician Fee Schedule. Read more.

Online Tool Shows Costs for Common Surgical Procedures 

The Centers for Medicare & Medicaid Services on Nov. 27 launched a new online tool that allows consumers to compare Medicare payments and co-payments for certain procedures that are performed in both hospital outpatient departments and ambulatory surgical centers. The Procedure Price Lookup tool displays national averages for the amount Medicare pays the hospital or ambulatory surgical center and the national average co-payment amount a beneficiary with no Medicare supplemental insurance would pay the provider. Read more.

OHA Reminds Members Location Addresses on Claims Must Match Medicare Records

Ohio’s Medicare Administrative Contractor, CGS, wants to make certain hospitals are verifying off-campus, outpatient, provider-based department location addresses on claims match exactly the address that has been provided and updated to CMS’ PECOs system. Read more.

New Medicare Card Mailing Update – Wave 6 Ends

CMS finished mailing cards to people with Medicare who live in Waves 1-5 and is beginning distribution in wave 6 states (Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Texas, Utah, Washington and Wyoming). Card mailing in Wave 7 states and territories continues. Ohio is in Wave 7. Read more.

UHC Announces Prior Authorization for Site of Care Outpatient MR/CT Services 

United Healthcare in October announced in its Provider Bulletin that the payer would be requiring specific criteria be met to support medical necessity when performing advanced radiological imaging procedures in hospital outpatient departments. Read more.

VA Choice Program Expands Claims Contractor Role 

The Veterans Administration announced Oct. 2 in a press release that the Triwest contract will extend and expand to cover the entire country for the Patient-Centered Community Care, PC3, and Veterans Choice Program, or VCP. Read more.

Ohio BWC Proposes 2019 OPPS, ASC Rules 

Ohio Bureau of Workers' Compensation released two proposed fee schedule rules on Outpatient Hospital Reimbursement Rule, Ohio Administrative Code 4123-6-37.2 to become effective May 1, 2019 and the current Ambulatory Surgical Center Services Rule, Ohio Administrative Code 4123-6-37.3 also set to be effective May 1, 2019. Read more.
 
  • CMS will host a webinar on Dec. 5 to review changes to the EHR Incentive Program for 2019 and 2020 as a result of the 2019 inpatient prospective payment system final rule. Providers can register for webinar here.
  • Save Tuesday, Dec. 11 from 10-11 a.m. for OHA’s Health Economics & Policy webinar "OHA Advocacy Update: State Political & Policy Preview 2019." Member hospitals can register here for the free webinar.
  • The November edition of the Ohio Bureau of Workers’ Compensation Provider e-News is available here.

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This publication is distributed to finance staff of OHA member hospitals. 

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Please contact OHA’s Health Economics & Policy team with questions or comments:
Ryan Biles, executive vice president, Ryan.Biles@ohiohospitals.org
Alyson DeAngelo, director, Aly.Deangelo@ohiohospitals.org 
Shawn Stack, director, Shawn.Stack@ohiohospitals.org
Daniel Vielhaber, manager, Daniel.Vielhaber@ohiohospitals.org 
Valerie Adams, executive assistant, Val.Adams@ohiohospitals.org