The AHA, which first brought the lawsuit against CMS, argued that the 2020 rate cuts for certain hospital clinic visits are illegal given the judge’s decision to throw out the original site-neutral payment policy in the previous year’s OPPS final rule. In December 2019, the Centers for Medicare and Medicaid Services said it would repay hospitals for cuts made in site neutral payments by automatically reprocessing calendar year 2019 claims for hospital outpatient services provided in off-campus provider-based departments that had been grandfathered under the Bipartisan Budget Act of 2015. However, CMS will continue the off-campus site-neutral clinic visit rate for 2020:  2020 site-neutral reimbursement will be implemented as per the 2020 OPPS Final Rule; clinic visits performed at grandfathered off-campus HOPDs will be paid 40% of the OPPS rate (this is being challenged in a lawsuit filed January 13, 2020). For 2020 and subsequent years, CMS planned to reimburse the grandfathered PBDs at the MPFS rate, which would equal 40% of the OPPS rate. Under the new site-neutral payments rule, PBD clinic visit services will be paid at the same rate as clinic visit services provided in standalone physician offices, even when the PBD is excepted. Advis consultants are specialized in site-neutral payments and other healthcare or operational matters. Site-neutral payments could also more easily include quality add-ons in the future. LUGPA Comments to CMS on Hospital Outpatient Prospective Payment System (“OPPS”) and Ambulatory Surgery Center (“ASC”) Payment System Final Rule for 2019 – January 2, 2019. This website uses a variety of cookies, which you consent to if you continue to use this site. Related: CMS Finalizes 340B, Site-Neutral Cuts for 2020. Between 2018 and 2020, the Centers for Medicare and Medicaid Services (CMS) updated the OPPS rate and proposed to phase in a 60 percent reduction over two years. The Alliance for Site Neutral Payment Reform is a coalition of patient advocates, providers, payers and employers, who support payment parity across site of service in order to decrease Medicare and commercial spending, ensure patients receive the right care in the right setting, lower taxpayer and beneficiary costs, and increase patient access. Congress has established a clear structure for CMS to make annual changes to payments for covered hospital outpatient services under Medicare. The revised Pricer went into production on November 4, 2019, and applies to claims with a line item date of service of January 1, 2019, and after. The agency has already started to automatically reprocess claims for hospital outpatient services paid at the reduced rate to abide by the Collyer’s decision to overturn the policy. by Robert King | Jul 17, 2020 12:41pm. Pexels | CC0. What Is Healthcare Revenue Cycle Management? CMS’ parent organization plans to appeal Collyer’s original decision, according to an announcement from last week. However, Collyer criticized CMS for building the site-neutral payment policy into the final rule for the 2020 OPPS. The cut was estimated to save Medicare and enrollees $800 million in 2020. On July 17, 2020, in a blow to health care providers, the U.S. Court of Appeals for the D.C. In November of last year, the Centers for Medicare & Medicaid Services (CMS) decided to move forward with a two-year … July 17, 2020 01:11 PM. CMS will repay hospitals for certain 2019 off-campus clinic visits (G0463):  2019 clinic visits provided in excepted (grandfathered) off-campus hospital outpatient departments (“HOPDs”) and paid at the reduced rate, will now be reprocessed automatically and paid at the full Outpatient Prospective Payment System (“OPPS”) rate. However, CMS will continue the off-campus site-neutral clinic visit rate for 2020: 2020 site-neutral reimbursement will be implemented as per the 2020 OPPS Final Rule; clinic visits performed at grandfathered off-campus HOPDs will be paid 40% of the OPPS rate (this is being challenged in a lawsuit filed January 13, 2020). Site-neutral payments, also called payment leveling or payment equalization, refers to a reduction in Medicare reimbursement discrepancies related to facility ownership. After this site neutral policy was finalized, the AHA challenged the policy in an effort to overturn this final rule. The Part A Hospital Insurance Trust Fund will become insolvent by 2024, according to Congressional … Consent and dismiss this banner by clicking agree. All rights reserved. To stop the payment cuts in 2020, hospitals will have to wait until the site-neutral payment policy harms them, meaning they receive reduced reimbursement for a hospital clinic visit claim next year. In September, the … Despite the ruling against the site-neutral payment policy, CMS included the next phase of the policy’s implementation in the final rule for the 2020 OPPS. Hospitals can expect the claims to be reprocessed by their Medicare Administrative Contractors starting in the new year. Notably, the reductions were not budget-neutral, meaning the savings were not redistributed within the OPPS. On September 17, 2019, a federal judge vacated the CMS site neutral payment rule for these clinic visits (see previous article). Related: Doc Groups Laud CMS' E/M Reforms, Red Tape Reductions. What Is Value-Based Care, What It Means for Providers? RevCycleIntelligence.com is published by Xtelligent Healthcare Media, LLC, Winners, Losers of the Medicare Site-Neutral Payment Policy Ruling, More Outpatient Site-Neutral Payments to Cut Costs, Coalition Says, The Difference Between Medicare and Medicaid Reimbursement, Bipartisan Bill Aims to Halt Site-Neutral Payments to Hospitals, Judge Reaffirms Decision to Overturn Site-Neutral Payment Policy, Grouping Groupers: How They Differ and Why That Can Impact Your ValueBased Care Strategy, A Better Emergency Department Patient Access Strategy. The fast-approaching insolvency of the Medicare hospital trust fund could spur a scramble for solutions, including leveraging value-based payment (VBP), some industry analysts say. Nursing Homes and Rehabilitation Hospitals are NOT the Same Rachel Cohrs Tweet Share Share Email More. 4. Another Blow for Hospitals: The Ongoing Battle of Site Neutral Payments. Hospitals have historically benefited from the Outpatient Prospective Payment System (OPPS), the reimbursement mechanism for Hospital Outpatient Departments (HOPDs) facility fees, in comparison to their private practice peers. For more information, please contact us online or call 708-478-7030. CMS also announced that week that it will repay hospitals impacted by the site-neutral payment policy in 2019. Therefore, 2020 clinic visits performed at grandfathered off-campus HOPDs will be paid at 40% of the OPPS rate. Clinic visits are the most common service billed under the OPPS. You can read our privacy policy for details about how these cookies are used, and to grant or withdraw your consent for certain types of cookies. The 2020 Final Rule is ultra vires for the same reasons as the 2019 Final Rule. The site-neutral payments will be phased in over two calendar years, 2019 and 2020. Court Reverses 340B Reimbursement Cut – January 30, 2019. To increase the sustainability of the Medicare program and improve quality of care for seniors, CMS is moving toward site neutral payments for clinic visits (which are essentially check-ups with a clinician). December 18, 2019 - Hospitals will still get paid the reduced rate for certain clinic visits in 2020 despite a federal judge striking down the site-neutral payment policy earlier in 2019. Alternatively, hospitals predicted a massive loss under the site neutral payments into the millions for many organizations. Advis 7840 Graphics Drive Suite 100 Tinley Park, IL 60477, It is our goal to provide industry news and trends through our newsletter. Site neutral payments would result in patients who need intensive inpatient rehabilitation being diverted inappropriately to less intensive settings based solely on their diagnosis, despite their clinical needs. Hospitals, Legal, Policy. The American Hospital Association, Association of American Medical Colleges and several hospital systems on Monday sued the Trump administration over … CMS to Repay Hospitals for 2019 Reductions, More Litigation to Follow. To stop the payment cuts in 2020, hospitals will have to wait until the site-neutral payment policy harms them, meaning they receive reduced reimbursement for a hospital clinic visit claim next year. Hospitals sue CMS again over site-neutral payments The American Hospital Association and the Association of American Medical Colleges sued CMS over a … Share. A federal judge will not stop CMS from implementing its site-neutral payment policy in 2020, according to an opinion filed Monday. Judge OKs 2020 Site-Neutral Payments, But Criticizes CMS Policy; The Difference Between Medicare and Medicaid Reimbursement; Site-neutral payments for outpatient services delivered in off-campus hospital provider-based departments have been on the chopping block before. The hospital group urged Collyer to stop CMS from enforcing the policy before the rate cuts are slated to take effect on Jan. 1, 2020. Circuit overturned a lower court’s more favorable ruling and held that the Department of Health and Human Services (“HHS”) “site-neutral payment” policy may stand. Starting January 1, 2020, and over the next few months, the Medicare Administrative Contactors will automatically reprocess 2019 claims paid at the reduced rate; no provider action needed.”. SUBSCRIBE TODAY >, FEMA Disaster Response and Recovery Consulting, 2021 OPPS and ASC Payment System Final Rule. “By continuing payment cuts for hospital outpatient clinic visits, CMS has not only undermined clear congressional intent, but has threatened to impede access to care, especially in rural and other vulnerable communities,” Pollack said. By Maggie Flynn | February 2, 2020 February 2, 2020. Site-neutral payments: “[T]he Budget proposes realigning incentives through site neutral payment reform to ensure accurate payments across different healthcare provider types are based on patient characteristics rather than site of care,” the overall budget says. For any questions related to the site-neutral litigation, claims reprocessing, or any other healthcare or operational matters, please contact Advis at (708) 478-7030. In the meantime, to comply with the court’s order, 2019 clinic visits paid at the reduced rate will be automatically reprocessed with no provider action required. In a partial welcome sign for hospitals, the Centers for Medicare & Medicaid Services (“CMS”) recently announced the following regarding site-neutral payment policy: As part of the 2019 OPPS Final Rule, CMS extended site neutral reimbursement to clinic visits performed at grandfathered HOPDs. Enter your email address to receive a link to reset your password, CMS to Repay Site-Neutral Payments to Hospitals, Appeal Case, Join 30,000 of your peers and get free access to all webcasts and exclusive content, ©2012-2020 Xtelligent Healthcare Media, LLC. Appeals court rules HHS has authority to implement site-neutral payments, dealing blow to hospitals. Facebook; Twitter ; LinkedIn; Send email; Just three months after the nursing home world saw a new Medicare payment model take effect, the home health industry dealt with its own sea change: the Patient-Driven … By Alex Spanko | February 10, 2020. CMS site-neutral payments may move forward in 2020, judge rules Laura Dyrda - Tuesday, December 17th, 2019 Print | Email Site-neutral payments have been in the news again with fresh challenges from the American Hospital Association. The opposite holds true for hospitals. Updated on: September 28, 2020 HHS Site-Neutral Pay Cuts are Legal By Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC Original story posted on: September 20, 2020 Appeals court rules HHS has the authority to reduce payments. Complete your profile below to access this resource. Collyer ruled against the policy in September, arguing that CMS could not reduce rates for certain hospital outpatient services in a non-budget-neutral manner. Despite on-going litigation over the cuts, CMS rolled out the second phase in the 2020 OPPS proposed rule. Advis recommends closely monitoring financial information to ensure 2019 claims are appropriately reprocessed. This is clearly a mistake, and could endanger vulnerable beneficiaries. 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