As reported by attorney Jeanne Helton, the 2015 Bipartisan Budget Act, signed into law by President Obama on November 2, 2015 prohibits newly created off-campus hospital outpatient departments from receiving provider-based Medicare reimbursement for non-emergency services beginning January 1, 2017.
The Budget Act revises the hospital Outpatient Prospective Payment System (“OPPS”) to prohibit reimbursement under the OPPS for services furnished in an off-campus facility, instead providing that such services must be reimbursed under the Medicare physician fee schedule.
The good news is that facilities that are billing as hospital outpatient departments as of November 2, 2015 may continue to receive provider-based payments under a grandfather clause included in the Budget Act. Also, facilities that meet the requirements of a “dedicated emergency department” under existing regulations are excluded from the prohibition and may continue to receive provider based reimbursement.
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