Medicare Outpatient Payment Policies Finalized

On November 1, CMS finalized updates to the Medicare Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Care Center (ASC) Payment System for the 2020 calendar year. In addition to updating payment rates, this rule finalizes completing the two-year phase-in of site neutral payment for clinic visits when provided at an off-campus provider-based department. This final rule also finalizes to pay Average Sale Price (ASP) minus 22.5 percent for 340B-acquired drugs for CY 2020. Rural sole community hospitals are still exempted from the reduction and will continue to be paid ASP plus 6 percent. In the rule, CMS finalizes a change to the generally applicable minimum required level of supervision for hospital outpatient therapeutic services furnished by all hospitals and Critical Access Hospitals (CAHs) from direct supervision to general supervision. CMS is also finalizing for the OPPS, the other wage index policies adopted in the FY 2020 IPPS final rule. CMS plans to finalize these provisions on price transparency and requirements for making public a list of standard charges in a standalone document at a later date. As part of this rulemaking, CMS is accepting comments on the payment classifications assigned to the interim APC assignments and/or status indicators of new or replacement Level II HCPCS codes until 5 pm EST on December 2, 2019.  Click here for more information from the Federal Register.