Medicaid eligibility is being re-determined in Ohio for the first time in three years. A federal mandate allowed Ohioans to stay enrolled in Medicaid insurance, even if their eligibility had changed, during the COVID-19 pandemic. Now the federal public health emergency has ended and April marks the end of that protection. More than 200,000 Ohioans are expected to be deemed ineligible and lose their coverage in the next year. The decline in Medicaid enrollment could mean big losses for community health centers, who largely serve low-income patients. Teresa Rios-Bishop, membership director of the Ohio Community Health Center Association, said the impact for centers will be significant. She said many communities are bracing for how this could change their care. “It certainly has a chilling effect for the patients and the health centers themselves,” she said. Nationally, total health center revenue is expected to decrease between four and seven percent, according to George Washington...

  An Ohio Doctor has been charged in a fraudulent medical supply scheme that targeted elderly Washington residents. Thomas Andrew Webster, M.D., 50, of Sylvania, Ohio was charged with  one count of Conspiracy to Violate the Anti-Kickback Statue by targeting  elderly Medicare and TRICARE beneficiaries throughout Washington and other states, according to a press release from the U.S. Attorney for the Eastern District of Washington's Office. The conspiracy charge carries a maximum sentence of up to five years in prison. “Telemarketing schemes that target and exploit the elderly are especially pernicious because they prey on those who are often most in need of a doctor’s independent judgment that is not tainted or biased by the doctor’s own personal financial interest,” said U.S. Attorney Vanessa Waldref. Medicare and TRICARE provide health insurance coverage for eligible health care services, including, under certain eligibility conditions, for Durable Medical Equipment (DME...

  As kids' Medicaid eligibility review gets underway, experts are concerned about the number of Ohio children  losing federal health insurance . Kelly Vyzral, senior health policy associate, Children's Defense Fund-Ohio, said because Ohio does not disaggregate information by adult or child, there is little data available on why kids are dropping off. She added whether their parents obtained employer-sponsored coverage or they lost coverage for procedural reasons like a change of address, the tend is troubling. "So we don't know why the 61,000 kids have lost their Medicaid coverage," she explained. "But there's a difference in the total number of children covered in April, versus the number covered in July. That's 61,000." According to the Georgetown Center for Children and Families, more than 38% of Ohio children rely on Medicaid or K-CHIP coverage. At the start of the school year, kids often need routine immunizations and physical exams for spor...

  A recent survey shows most consumers— 72% — don’t or can’t pay their medical bills in full right away, with affordability being a top barrier. Healthcare revenue cycle leaders may need to readjust their patient collection strategy to help consumers understand and pay their medical bills, a new  survey  suggests. The survey of over 1,000 consumers conducted by AccessOne found that fewer than one in three respondents pay their medical bills in full right away, leaving a remaining 72 percent of consumers waiting to pay healthcare-related expenses. The latter respondents said they either can’t or don’t pay their medical bills right away and need different options and support. Some consumers who don’t pay medical bills immediately simply haven’t paid as of yet (13 percent), while 7 percent wait until just before the bill’s due date to pay in full and 2 percent pay after the due date. Affordability is a major challenge  for consumers. About 68 percent of consumers respon...

  It seems as if  commercial payers are doing all they can to keep from reimbursing providers in a timely manner. According to a recent  report by Crowe , 31% of claims submitted to commercial payers in the first quarter of 2023 were not paid for at least three months, as compared with 12% of Medicare claims. Medical necessity denials have risen as well. During the same timeframe, inpatient claims denied due to medical necessity issues were 3.2% among commercial payers and 0.2% for Medicare. Commercial payers have 12 times the denial rate that Medicare has based on requests for more information, according to Crowe. The following are three key interventions providers can implement now to help them do just that. Key intervention 1 Negotiation and contract m anagement optimization Hospitals can work with hundreds of payers, each with its own contract terms, processes,and ever-changing requirements. Managing these contracts can be challenging for resource-strapped organizatio...

  © yavdat - stock.adobe.com Simply  stated , “[p]ursuant to section 205 of the Health Insurance Portability and Accountability Act of 1996 ( HIPAA ), Public Law 104–101, codified at section 1128D of the Social Security Act (Act), the Secretary must publish advisory opinions regarding the application of the Federal anti-kickback statute and the safe harbor provisions, as well as certain other administrative sanction authorities, to parties’ proposed or existing arrangements.” For those unfamiliar with U.S. Department of Human of Health and Human Services Office of the Inspector General’s (HHS OIG) advisory opinions, an advisory opinion may be requested with regards to the following: What constitutes prohibited remuneration under the Federal anti-kickback statute; Whether an arrangement or proposed arrangement satisfies the criteria in section 1128B(b)(3) of the Act, or established by regulation ( i.e. , safe harbors), for activities which do not result in prohibited remunerati...

  Accurate and efficient medical billing for any healthcare facility is a must for a great revenue stream and undisrupted cash flow. Even when you are hiring professionals from a reputable  medical billing company  to handle all your billing-related matters, you still may have certain doubts in your mind about whether outsourcing is right or not. Furthermore, other common myths related to medical billing itself may also be causing your healthcare facility to be behind your competitors as well as financially. Of course, you want to provide the best patient care, and it also involves smooth billing. In this article, we’ll share the common myths about medical billing and the facts to help you run your healthcare practice successfully. Myth #1: Only Medical Knowledge and Materials Is Required While it’s true that a medical billing team should have a solid knowledge of medical terminologies and common diseases to perform their best at work. Nevertheless, you need to know more ...