General Question for the Week of August 20, 2018

Question:

How would the CMS site-neutral payment policy work?

Answer:

The Centers for Medicare & Medicaid Services (CMS) have proposed a policy to adopt site-neutral payments for clinic visits (i.e., essentially check-ups with a clinician)—the most common service billed under the OPPS. Currently, CMS often pays more for the same type of clinic visit in the hospital outpatient setting than in the physician office setting, and this policy, if finalized, would equalize payment.

In fact, CMS projects a savings of about $150 million in lower copayments for clinic visits provided at an off-campus hospital outpatient department. It also proposes to close a potential loophole through which providers are billing patients more for visits in hospital outpatient departments when they create new service lines.