Starting by July 1, the Centers for Medicare & Medicaid Services will reprocess calendar year 2019 claims for hospital outpatient clinic visit services provided in off-campus provider-based departments excepted under the Bipartisan Budget Act of 2015 to pay them at 70% of the outpatient prospective payment system rate, the same rate as non-excepted departments, the agency announced today.

AHA members will receive a Special Bulletin with more information.

A federal judge in 2019 ruled that CMS exceeded its statutory authority when it reduced payments for hospital outpatient clinic visit services provided in off-campus provider-based departments excepted under the act, siding with AHA and other hospital organizations that challenged the cut.

CMS reprocessed the claims starting in January 2020 to repay the cut. An appeals court then reversed the district court ruling. AHA will ask the U.S. Supreme Court to review the appeals court decision.

Related News Articles

Headline
Medicare patients who receive care in a hospital outpatient department are more likely to be poorer and have more severe chronic conditions than Medicare…
Headline
The Medicare Payment Advisory Commission yesterday recommended that Congress require the Centers for Medicare & Medicaid Services to transition to a…
Headline
AHA yesterday urged the Centers for Medicare & Medicaid Services to rescind its recent audit determinations denying hospitals a mid-build exception to…
Headline
State and regional hospital associations today filed friend-of-the-court briefs supporting AHA’s request for the U.S. Supreme Court to review two circuit court…
Headline
The AHA, joined by member hospitals and health systems and other national organizations representing hospitals, yesterday filed petitions asking the U.S.…
Headline
The AHA and the Association of American Medical Colleges today announced they will seek a rehearing in the U.S. Court of Appeals for the District of Columbia…