CMS to reprocess some 2019 outpatient claims after ruling on site-neutral payments

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CMS will reprocess calendar year 2019 claims for outpatient services provided at excepted off-campus provider-based departments due to an appeals court ruling on site-neutral payments, the agency said Jan. 14.

The agency will begin automatically reprocessing the claims by July 1. The excepted off-campus provider-based departments will be paid at 70 percent of the outpatient prospective payment system rate, which is the same rate as non-excepted departments.

Under the 2019 Medicare Outpatient Prospective Payment System final rule, 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.

The American Hospital Association sued over the site-neutral payment policy, and in 2019 a federal judge ruled that CMS exceeded its statutory authority when it cut payments for hospital outpatient services provided in off-campus provider-based departments excepted under the Bipartisan Budget Act of 2015. 
 
However, a group of appellate judges in July 2020 overturned the lower court ruling and held that HHS' site-neutral payment policy can go forward. 

CMS reprocessed the claims last year to repay the cuts, but now it will include the cuts.

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