News & Updates

November 5, 2019

Alliance Applauds Inclusion of Site Neutral Payment Policies in Final OPPS Rule

Advocacy group strongly supports continued implementation of site neutral payments for outpatient clinic visits

WASHINGTON— The Alliance for Site Neutral Payment Reform commends the Centers for Medicare & Medicaid Services (CMS) for including provisions in the Calendar Year (CY) 2020 Hospital Outpatient Prospective Payment (OPPS) and Ambulatory Surgical Center (ASC) Payment Systems Final Rule, which will enable the continued implementation of site neutral payments for outpatient clinic visits.

On November 1, CMS finalized the continued two-year phase-in of site neutral payments for Evaluation and Management (E/M) services – one of the most common clinic services. This policy will apply the Physician Fee Schedule (PFS) equivalent rate for E/M services when provided at an off-campus hospital outpatient department (HOPD) that currently bills Medicare under the OPPS.

According to CMS, the Final OPPS Rule will save Medicare an estimated $800 million in 2020 alone.

In a September 27 letter to CMS, the Alliance applauded “CMS for its continued commitment to site neutral payment reform in the 2020 proposed rule and strongly supports its efforts toward ensuring the exact same service is reimbursed at the same rate despite the setting.”

Data indicate current payment differentials between the OPPS and the PFS payments rates incentivize hospitals to acquire freestanding physician practices to gain access to higher reimbursement rates. The Administration’s attention to the negative consequences payment disparities have had on patient access to care and consolidation has been commended by the Alliance, which has repeatedly urged CMS to examine other opportunities to equalize payment rates.

The letter continued, “The Alliance fully supports this proposal and encourages CMS to continue exploring opportunities to implement site neutral payments for all clinically appropriate outpatient services.”   


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