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Ohio Medicaid's New Payment System Delayed

New Implementation Date - August 1

Ohio Medicaid's New Payment System Delayed

New Implementation Date - August 1

(Medicaid Prior Authorization Webinar on 6/14)


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Ohio Department of Medicaid (ODM) is moving forward with a new payment system for ASCs and Hospital Outpatient Services but as a result of issues in the state government rule making process, the implementation date has been moved from July 1 to August 1, 2017.


As a reminder, the new payment system moves away from the current system to a new structure that seems to be somewhat similar to current Medicare APC.   The new Enhanced Ambulatory Patient Grouping (EAPG) system is intended to modernize payments of all outpatient services and was developed by 3M Health Services.


ODM will still be in charge of all overall payment levels (e.g., how much they pay ASC as a % of HOPDs), but the new methodology will incorporate bundling (packaging) of codes into a single payment for certain procedures and discounting for multiple procedures. ODM is setting the base rate for ASCs at 80% of Hospital Outpatient rates and while most procedures are expected to reimbursed at a higher rate than current Medicaid, some will not.  The OAASC raised concerns about a reduced rate for basic GI procedures and ODM is now working to address these concerns and hopes to have it addressed before implementation.


For more information on the system, please see the resources BELOW provided by ODM at the recent Coding Clinic. We are also working with them for additional training opportunities.


Prior Authorization Webinar 

Additionally, a part of the program will require prior authorization for certain codes, which is currently not in the ASC system.


To assist OAASC members with this change, ODM will be holding a free training on prior authorization on June 14th, 2017 at 2pm.


Attend via webinar - Please register at:
After registering, you will receive a confirmation email containing information about joining the webinar.


ODM will also be recording the webinar and will post it to their website (linked from the OAASC web site) for anyone who can’t make it or wants to view it again.



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EAPG Claims Examples



If you or your staff have any questions, please do not hesitate to contact the OAASC at 614-358-0177 or