September 2018
Spotlight: Push Toward Site-Neutral Payments Continues
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Hospital prices are again in the spotlight as the Centers for Medicare & Medicaid Services (CMS) moves to eliminate the payment differential between clinic visits at hospital-owned outpatient facilities and independent facilities.
In its Outpatient Prospective Payment System (OPPS) proposed rule for 2019, released on July 25, 2018, CMS proposes that payment for clinic visits at off-campus hospital outpatient departments (HOPDs) be paid at the same rate as a clinic visit in an independent physician office setting. This follows an earlier step toward site neutrality taken with the Bipartisan Budget Act of 2015. Under that act, an ambulatory surgery center (ASC) acquired or established by a hospital after November 2, 2015, cannot bill for services at the higher HOPD rate. Instead, it must bill at the same rate as a freestanding ASC. ASCs acquired or established before the November 2015 cutoff are “grandfathered,” and can continue to bill at the higher HOPD rate. The new proposed rule for clinic visits, however, applies to grandfathered and non-grandfathered facilities alike.
Push Toward Site-Neutral Payments Continues
Impact of Proposed Average Rates
Outpatient and Ambulatory space
Site-Neutral Payments
Impact of Proposed Average Rates
Outpatient and Ambulatory space
Site-Neutral Payments
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