CMS site-neutral payments may move forward in 2020, judge rules

Site-neutral payments have been in the news again with fresh challenges from the American Hospital Association.

On Dec. 16, A federal judge ruled the courts were not able to stop CMS from moving forward with its payment update for off-campus providers next year, which reduces the payment for off-campus evaluation and management services. The AHA sued CMS earlier this year, along with several hospitals, to prevent the rule from going into effect.

A U.S. District Judge ruled that CMS overstepped its authority in September, but that didn't prevent CMS from finalizing the site-neutral payment cuts in the 2020 final rule. However, when the AHA asked the judge to uphold her decision to prevent the cuts, she ruled the court didn't have jurisdiction to halt the pay cuts.

On Dec. 12, CMS agreed to reimburse hospitals for millions that was withheld during a policy dispute over the OPPS rule for 2019, which aimed to make payments for management and services visits site neutral. CMS reduced the evaluation and management services rates by around 60 percent for off-campus provider-based departments, which AHA claims amounted to $380 million.

CMS plans to repay the hospitals beginning in January 2020 if they were paid at the 60 percent reduced rate.

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