CMS to Move Forward with Site-Neutral Payment Policy Following Judge’s Ruling

December 2019 ~

CMS has announced that, following a federal court ruling, the agency plans to move forward with its site-neutral payment policy for physician visits in 2020.

In September, U.S. District Judge Rosemary Collyer ruled against the policy for 2019 payments under the reasoning that CMS could not reduce rates for certain hospital outpatient services in a non-budget-neutral manner. Despite that ruling, the agency continued with their plan to implement similar cuts under the 2020 Outpatient Prospective Payment System rule.

The American Hospital Association asked the judge to apply her previous decision to 2020, as well, and on December 16, Judge Collyer ruled that the court does not have jurisdiction to intercede, noting that “As a technical matter, the government correctly argues that the Court’s previous order was limited only to the 2019 Final Rule.”

“CMS will continue to work to ensure that Medicare has more choices that would lower out-of-pocket costs” a CMS spokesperson said in a statement. “There is significant payment disparity between Medicare payments for clinic visits in certain off-campus hospital outpatient departments versus the physician office setting. CMS looks forward to implementing policies that will result in lower copayments for Medicare beneficiaries.”

The site-neutral payment policy is intended to reduce healthcare spending by paying the same amount for a medical visit, regardless of location (i.e. hospital outpatient facility or physician’s office). The agency estimates it would reduce federal spending by $800 million in 2020.

Source(s): Modern Healthcare; Healthcare DIVE; RevCycleIntelligence; SmartBrief;