In recently issued frequently asked questions (FAQs) on its website, the Centers for Medicare & Medicaid Services (CMS) provides details on its process for auditing mid-build attestations under the 21st Century Cures Act.
The 21st Century Cures Act added an exception from site-neutral payments for off-campus provider-based departments (PBDs) that were being built when Section 603 of the Bipartisan Budget Act of 2015 was enacted. For an off-campus PBD to qualify for an exception from the reduced Section 603 payment rate, the hospital had to have had a binding written construction agreement before Nov. 2, 2015. Hospitals had to submit mid-build application materials to their Medicare administrative contractor (MAC) by Feb. 13, 2017.
CMS will audit mid-build certifications this year and should complete all audits by December 2018. In 2018, PBDs that have submitted a mid-build application and are awaiting a final audit determination can treat their claims in one of three ways:
- hold those claims until a final audit determination has been made as to whether the PBD meets the mid-build requirement;
- append a PO modifier to the claims, which would result in payment at the higher Outpatient Prospective Payment System rate; or
- append a PN modifier (modifier for non-excepted PBDs resulting in site-neutral payment rate) if the hospital is unsure if the PBD in question meets the mid-build requirements.
CMS also notes in the FAQs that a hospital should contact its MAC directly if it did not receive confirmation after submitting its mid-build attestation package.
Update, July 20, 2018: This article has been refreshed with a link to CMS’ updated version of the FAQs, revised June 6. The new FAQs contain additional information about the mid-build audit process, conducted by Cahaba Safeguard Administrators (CSA). Once the audits are complete, CSA will send a determination letter on CMS letterhead to hospitals that submitted a timely mid-build application.
Contact Director of Policy Erin O’Malley at firstname.lastname@example.org or 202.585.0127 with questions.