AHA urges CMS to rescind recent ‘mid-build exception’ denials

AHA yesterday urged the Centers for Medicare & Medicaid Services to rescind its recent audit determinations denying hospitals a mid-build exception to site-neutral payment under the 21st Century Cures Act. While the Cures Act required CMS to complete these audits before Dec. 31, 2018, the audits were completed and hospitals notified of the results more than two years after this date, resulting in inappropriately reduced payment rates for items and services furnished by certain off-campus provider-based departments that first billed Medicare for services furnished on or after Nov. 2, 2015, AHA wrote. 

“Specifically, providers that submitted mid-build exception requests must be excluded from the definition of ‘off-campus outpatient department of a provider’ in all instances where CMS has failed to timely render a contrary determination as part of a mid-build audit completed on or before Dec. 31, 2018,” wrote Tom Nickels, AHA’s executive vice president for government relations and public policy.