Providers do not need to take action, CMS stated in the bulletin. The rate cut applies to off-campus provider-based departments excepted from previous site-neutral payment policies under the Bipartisan Budget Act of 2015. However, in July 2020, the US Court of Appeals for the DC circuit reversed the previous judge’s ruling on the policy and upheld the site-neutral payment reduction.ĬMS is now reprocessing the 2019 hospital outpatient claims again to reimburse clinic visit services delivered at off-campus provider-based departments the lower rate. In 2019, a federal judge declared invalid the rate cut finalized in the 2019 OPPS final rule, which aimed to lower hospital outpatient volume for services that can be safely be delivered in a physician’s office at a lower cost.ĬMS reprocessed the 2019 hospital outpatient claims impacted by the so-called site-neutral payment policy in early 2020. ![]() The new rate for the clinic visit services delivered in hospital off-campus provider-based departments is 70 percent of the full rate under Medicare’s Outpatient Prospective Payment System (OPPS). The agency will start reprocessing the claims in July 2021 in order to pay all hospitals the same rate as non-excepted off-campus provider-based departments for clinic visit services paid under the Physician Fee Schedule, according to the announcement in a Jan. ![]() CMS has announced that it will reprocess hospital outpatient claims from last year for clinic visit services provided at excepted off-campus provider-based departments.
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