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CMS Reverses 2019 Site-Neutral Cut, Files Appeal

The Centers for Medicare & Medicaid Services (CMS) has begun complying with a court decision invalidating its 2019 Medicare site-neutral payment cuts to clinic visits.

In a decision earlier this year, the U.S. District Court for the District of Columbia vacated CMS’ 2019 policy to cut Medicare outpatient payments by 30 percent to grandfathered, off-campus provider-based departments. The court remanded the case to CMS to determine how to pay hospitals back for the payment cuts. In the 2020 Outpatient Prospective Payment System (OPPS) final rule, CMS noted that it was determining how to pay hospitals back for 2019 claims that were paid at the reduced 70 percent rate.

CMS on Nov. 4 adjusted the software that processes OPPS payments. Newly filed claims, since that date, should be paid at the full OPPS payment rate. The agency also states that beginning Jan. 1, 2020, it will begin to adjust claims that already were paid at the reduced rate. This process will last a few months. CMS notes that providers do not need to take any additional action.

Meanwhile, the agency also filed a notice appealing its case to the U.S. Court of Appeals for the District of Columbia Circuit.

Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Shahid Zaman is a senior policy analyst at America's Essential Hospitals.

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