CMS Agrees to Pay for Clinic Visit Services Furnished in Excepted Off-Campus Provider-Based Departments at the Full OPPS Rate

CMS has announced that it will reimburse hospitals for clinic visit services furnished in excepted off-campus provider-based departments at the full OPPS rate without the payment reduction set forth in the agency’s CY 2019 OPPS final rule. CMS explains that it has installed a revised OPPS Pricer to update the payment rates applied to claim lines. The revised Pricer went into production on November 4 and applies to claims with dates of service January 1, 2019 and after. CMS describes that starting January 1, 2020, the MACs will automatically reprocess claims paid at the reduced rate and hospitals do not need to take any action. CMS’ announcement is included in its December 12 Medicare Learning Network Connects available at link here.