News: 2019 OPPS final rule brings site-neutral payment cuts, AHA plans to sue

CDI Strategies - Volume 12, Issue 53

CMS released the 2019 Outpatient Prospective Payment System (OPPS) final rule on Friday, November 2, implementing several site-neutral payment policies. Though many of the OPPS changes will bring reimbursement decreases, CMS is increasing payment rates for outpatient hospital departments by 1.35%, estimating total 2019 payments of $74.1 billion, an increase of approximately $5.8 billion over estimated 2018 payments.

However, the agency did delay, or shelve, other proposals due to stakeholder feedback. 

Beginning January 1, 2019, CMS is expanding its controversial drug payment policy by reducing the reimbursement for separately payable 340B-acquired drugs provided in a nonexcepted, off-campus, provider-based department (PBD) to average sales price (ASP) minus 22.5% under the adjusted Medicare Physician Fee Schedule amount. These drugs are generally reimbursed at ASP plus 6% currently, Revenue Cycle Advisor reported.

The American Hospital Association (AHA) and other hospital groups have been engaged in lawsuits against CMS for nearly a year after the agency implemented a similar payment reduction in the 2018 OPPS final rule for 340B drugs furnished in outpatient hospital departments.

According to a press release from the AHA, the organization plans to add the newest changes to their list of suits against CMS, calling the final rule “misguided” and based on “unsupportable analyses and erroneous policy rationales.”

Editor’s note: To read Revenue Cycle Advisor’s coverage of this story, click here. For more information on the 2019 OPPS final rule, see the press release and fact sheet. To read the AHA press release, click here.

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