CMS Will Return Payments Under Site Neutrality, But Filed Appeal

Just in time for the holidays, CMS announced that Medicare administrative contractors (MACs) will start returning payments that hospitals lost in 2019 for clinic visits under the site-neutral payment policy.[1] At the same time, CMS’s court battle with hospitals rages on.

MACs “will automatically reprocess claims paid at the reduced rate” through its site neutrality policy, which pays for outpatient clinic visits (G0463) provided at excepted off-campus provider-based departments (PBDs) at the same rate that CMS pays non-excepted off-campus PBDs and freestanding clinics under the Medicare Physician Fee Schedule, according to an MLN Connects that was released Dec. 12 and updated Dec. 18. The cuts, announced in the 2019 final Outpatient Prospective Payment System regulation, are being phased in—30% in 2019 and double in 2020. Their future is in question. The American Hospital Association (AHA) and dozens of hospitals challenged the cuts in court, and Judge Rosemary Collyer of the U.S. District Court for the District of Columbia killed the site-neutral payment policy, but only for 2019, in a September decision.[2]

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