Medicare site-neutral payments

Hospitals Rally Against Medicare Site-Neutral Payments

A proposal to save Medicare nearly $4 billion over a decade is running into stiff opposition. From hospitals. – and some members of Congress. Medicare has long paid more for outpatient services provided in hospital-based outpatient departments than it has for the same services delivered in private doctors’ offices.  Critics say this is unfair, that Medicare should pay the same no matter where the service is provided.  Defenders of the practice maintain that hospital-based outpatient departments share higher fixed costs, including for ERs and care for uninsured patients.  They also argue that reducing such Medicare outpatient payments could threaten the [...]

2024-02-15T13:42:15+00:00February 16, 2024|Medicare, Medicare reimbursement policy|

Federal Health Policy Update for December 7

The following is the latest health policy news from the federal government for December 1-7.  Some of the language used below is taken directly from government documents. Congress While Congress has more than a month before the next federal funding deadline of January 19, committees are working to prepare and pass health care legislation. On the House calendar for floor votes next week is H.R. 5378, the Lower Costs, More Transparency Act.  This bill would eliminate the pending cuts to Medicaid DSH for two years (those cuts are temporarily suspended through January 19); introduce site-neutral payments for drug administration services [...]

MedPAC Urges Congress to Embrace Site-Neutral Medicare Outpatient Payments

Medicare should pay for outpatient care on a site-neutral basis, MedPAC has told Congress in its annual recommendations. Proponents of such a change – including the Medicare Payment Advisory Commission – argue that Medicare should not pay more for services than it needs to and can, if it believes hospital-associated facilities deserve more money, find better ways to provide such additional resources.  They also believe such a policy encourages the acquisition of independent medical practices by operators that then increase the price of the same services and that site-neutral payments would help preserve such independent practices while also driving down [...]

2023-06-26T06:00:56+00:00June 26, 2023|Medicare, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for May 25

The following is the latest health policy news from the federal government for May 19-25.  Some of the language used below is taken directly from government documents. Congress The House Energy and Commerce Committee has advanced to the full House two bills with significant implications for health care providers. H.R. 3561 calls for delaying $8 billion a year in Medicaid DSH cuts for two years – cuts scheduled to take effect in October; imposing site-neutral payments for drug infusion services provided in off-campus hospital outpatient departments; imposing stronger price transparency requirements on hospitals; and requiring hospitals to report selected ownership [...]

Federal Health Policy Update for May 18

The following is the latest health policy news from the federal government for May 12-18.  Some of the language used below is taken directly from government documents. Congress The House Energy and Commerce Health Subcommittee has approved and advanced five bipartisan health care bills. H.R. 3281 combined a number of proposals into a larger package and includes provisions that would: delay for two years Medicaid disproportionate share (Medicaid DSH) cuts currently scheduled to take effect on October 1; require health providers to use a unique identifier for each off-campus or remote outpatient department beginning in 2026; change how Medicare pays [...]

Good News and Bad for Hospitals on Outpatient Payments

A federal court has provided relief to hospitals that saw reduced Medicare payments for some outpatient services in 2019. But that relief is only partial. In response to a suit filed by several hospital groups, a federal court ruled that the Centers for Medicare & Medicaid services had illegally reduced Medicare payments for services provided in some hospital off-campus outpatient departments beginning on January 1, 2019 and ordered the federal government to repay the hospitals for the Medicare revenue they lost.  The reduced payments were part of a new Medicare site-neutral payment policy for outpatient services, and CMS has announced [...]

Court Halts Medicare Site-Neutral Payment Changes

The Centers for Medicare & Medicaid Services did not have the authority to implement the site-neutral payment system for Medicare-covered outpatient services that it introduced last year, a federal court has concluded. According to the court, CMS exceeded its authority because it …was not authorized to ignore the statutory process for setting payment rates in the Outpatient Prospective Payment System and to lower payment rates only for certain services provided by certain providers. In general, hospitals oppose the movement toward site-neutral payments and independent physician groups support it. The court did not order CMS to reimburse affected physician practices for [...]

Hospitals Sue Over Site-Neutral Outpatient Payment Policy

Nearly 40 hospitals have filed a joint lawsuit in opposition to the Centers for Medicare & Medicaid Services’ site-neutral payment policy for Medicare-covered outpatient services. In the suit, the hospitals charge the federal government with overstepping its authority in implementing such a change through regulation in the face of past congressional action to limit the use of site-neutral payments. Under its site-neutral payment policy, Medicare pays the same for some outpatient services regardless of where those services are provided.  Under Medicare’s previous policy, Medicare paid more for services provided in hospital-run outpatient facilities. Hospitals argue that their outpatient facilities are [...]

CMS: More Medicare Site-Neutral Payments Coming

The federal government is unlikely to stop with outpatient visits in its drive to make more Medicare payments on a site-neutral basis. That was the message Centers for Medicare & Medicaid Services administrator Seema Verma delivered at a public event last week. We are taking a look at [site-neutral payments] across the board and looking at our authority and where we can weigh in on it.  But I think the post-acute space is something where there are a lot of differentials in payments and something we’re very interested in exploring. CMS recently proposed extending its use of site-neutral payments for [...]

New Reg Pushes Medicare Toward Site-Neutral Outpatient Payments

Medicare would make more payments for outpatient services on a site-neutral basis under a newly proposed regulation just released by the Centers for Medicare & Medicaid Services. The 2019 Medicare outpatient prospective payment system regulation, published in proposal form, calls for: paying physician fee schedule rates rather than hospital outpatient rates at excepted off-campus provider-based departments; slashing payments for office visits; extending this year’s 340B prescription drug discount payments, already cut nearly 30 percent this year, to additional providers; and raising ambulatory surgical center rates and expanding the list of procedures that can be performed in such facilities so they [...]

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