New OPPS/ASC proposed rule released by CMS
The rule suggests applying the site-neutral provisions found in Section 603 from the Bipartisan Budget Act of 2015, a section mandating that services located in off-campus-based departments should have billed the OPPS by or after Nov. 2 of last year. Now, as of Jan. 1, 2017, this will no longer be paid through the OPPS but through Part B payment systems.
The new proposal requires that the physician fee schedule become the applicable payment system for most of the services with site-neutral rates and with locations on new, off-campus PBD.
More specifically, the CMS offers to pay doctors the higher “nonfacility” PFS rate without any direct payments from Medicare to the hospital.
This means that current off-campus PBDs that feature new clinical families will gain the site-neutral rates for these services. Existing off-campus PBDs that change locations post Nov. 2 will no longer have this status and will only have site-neutral payments; current off-campus PBD that change owners could lose the status if the new management does not accept the agreement from the Medicare provider.
“We are extremely dismayed by the short-sighted policies in today’s proposed rule,” AHA Executive Vice President Tom Nickels said. “Taken together, it appears that CMS is aiming to freeze the progress of hospital-based health care in its tracks. We will submit detailed comments to the agency, urging them to revise these misguided policies so that hospitals can continue to provide the highest quality health care to their communities.”
Organizations in this story
American Hospital Association 155 N Upper Wacker Dr Chicago, IL - 60606