Medicare: Site-Neutral Payments on Tap for 2019
According to a final rule issued November 2, 2018, the longstanding Medicare policy in which healthcare payments varied based on the setting is about to expire.
The rule came as part of the 2019 Medicare Hospital Outpatient Prospective Payment System (HOPPS) and Ambulatory Surgical Center (ASC) payment system rule by the U.S. Centers for Medicare and Medicaid Services (CMS). In releasing the rule, CMS said that moving to site neutrality is necessary to make healthcare more accessible and affordable for patients.
As we reported in mid-September, The Centers for Medicare and Medicaid Services released its 2019 Medicare Outpatient Prospective Payment System proposed rule on July 25th, which calls for site-neutral payments and would make changes to the 340B program.
AuntMinnie.com (the first comprehensive community internet site for radiologists and related professionals in the medical imaging industry) reports:
“CMS is exercising its authority to … control unnecessary increases in the volume of covered hospital outpatient department services by applying a Physician Fee Schedule-equivalent payment rate for the clinic visit service when provided at an off-campus provider-based department that is paid under the OPPS,” the agency said. “Currently, Medicare and beneficiaries often pay more for the same type of clinic visit in the hospital outpatient setting than in the physician office setting. This policy [will] result in lower co-payments for beneficiaries and savings for the Medicare program in an estimated amount of $380 million for 2019.”
The rule finalizes a 1.25% increase of the HOPPS conversion factor, bringing it up to $79.54 for 2019. A lower conversion factor of $77.95 will be used for hospitals that fail to meet Medicare’s Hospital Outpatient Quality Reporting program requirements.
As for ambulatory surgical center payments, CMS suggested updating these rates by 2.1%, in the hope that this change will “help to promote site-neutrality between hospitals and ASCs and encourage the migration of services from the hospital setting to the lower-cost ASC setting.”
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