CMS to repay hospitals millions for off-campus clinic visits

Medicare will soon reimburse hospitals millions of dollars that were withheld over a payment policy dispute, CMS said Dec. 12.

In its final Outpatient Prospective Payment System Rule for 2019, CMS made payments for clinic visits site-neutral by reducing the payment rate for evaluation and management services provided at off-campus provider-based departments by 60 percent. 

In an attempt to overturn the rule, the American Hospital Association and dozens of hospitals sued CMS, arguing the department exceeded its authority when it finalized the cuts in the OPPS rule. A federal judge sided with the AHA and other hospitals in September.

The AHA claimed that affected hospitals were shorted about $380 million in Medicare payments in 2019 from the rate cut.

Beginning Jan. 1, 2020, Medicare administrative contractors will begin repaying hospitals that were paid at the 60 percent reduced rate. Providers will be repaid automatically.

"The AHA is pleased that at our urging, CMS will be repaying affected hospitals the full OPPS rate for 2019 to support the critical work they do for the patients and communities they serve." the AHA said in response to CMS' announcement. "Now that a federal court has sided with the AHA and found these outpatient clinic visit cuts exceed the administration's authority, we continue to call on CMS to abandon further illegal cuts for 2020 and to pay the full OPPS rate going forward."

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