CMS Clarifies Site-Neutral Medicare Reimbursement Exceptions

January 2017 ~

Site-neutral Medicare reimbursement policy became effective as of January 1. As an aid, CMS has released guidance regarding the provisions of the 21st Century Cures Act which affect site-neutral payment provisions of the Bipartisan Budget Act of 2015.

The Cures Act, signed into law on December 13, revised the site-neutral payment policy enacted by Section 603 of the Bipartisan Budget Act. Per Section 603, certain off-campus provider-based departments that began billing under the Outpatient Prospective Payment System on or after November 2, 2015, are no longer be paid for most services under the OPPS beginning this year.

Facilities that had concrete plans in place to build a new off-campus outpatient department before November 2, 2015 are exempt, under the Cures Act, as well, newly built off-campus outpatient departments planning to accept patients prior to December 2, 2015, and submitted proper attestation to CMS are exempted from the Bipartisan Budget Act’s site-neutral payment provisions. The guidance clarifies that these facilities will be exempt from the site-neutral payment provisions in 2018 if they meet mid-build requirements.

To be exempted, hospitals must establish a binding written agreement for the actual construction of the off-campus department, prior to November 2, 2015. To qualify for the exemption in 2018, the hospital must submit the required attestation and certification documents to its Medicare Administrative Contractor by February 13, 2017.

Source(s): RevCycleIntelligence; Becker’s Hospital CFO; CMS Note Regarding Implementation(pdf); CMS Extraordinary Circumstance Relocation Exception Guidance(pdf);