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CMS to take next step in site-neutral pay for off-campus clinics

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CMS will move forward with site-neutral pay initiatives for outpatient clinic visits for hospital services provided at off-campus facilities.


Three details:

1. The agency plans to start reprocessing claims for outpatient clinic visits at off-campus provider-based departments Nov. 1 in accordance with the 2019 Outpatient Prospective Payment System final rule, which neutralized pay rates between all off-campus hospital departments and physician offices.

2. CMS will reprocess payments for services rendered during the 2019 calendar year, and providers will be required to refund coinsurance differences to patients who paid a higher rate.

3. The U.S. District Court for the District of Columbia declared the final payment rule invalid in September 2019, but the U.S. Court of Appeals for the D.C. Circuit reversed the decision in July 2020 to uphold the volume control site-neutrality payment policy.

ASCs have been watching site-neutral policies closely and have championed CMS closing the gap in pay methodologies for hospital outpatient surgery departments and independent ASCs. CMS pays hospital outpatient departments at a higher rate than ASCs for the same procedures.

Click here to read more details on site-neutral payments.

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