CMS urged to give hospitals a break from lower payments under site-neutral policy

The American Hospital Association is urging CMS to rescind recent decisions to deny member hospitals' requests for a midbuild exception to the site-neutral payment policy. 

The AHA said that the denials "inappropriately reduced payment rates for items and services furnished by certain off-campus provider-based departments that first billed Medicare for services furnished on or after Nov. 2, 2015."

Under the 21st Century Cures Act, CMS can deny midbuild exceptions only if an audit of the provider was completed by Dec. 31, 2018. CMS said in a March letter that it performed all audit activities in accordance with the Cures Act requirements, but the agency didn't meet the 2018 deadline, according to the AHA. As a result, it is notifying hospitals about the exception denial now.

The AHA is asking CMS to rescind the denial determinations for providers, especially in all instances where CMS failed to provide a timely determination as part of a midbuild audit completed before Dec. 31. 

"The issuance of these denials could not have come at a worse time for hospitals that are struggling both financially and with staff and resource shortages due to the pandemic," the AHA wrote. 

 

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