News: CY 2020 OPPS final rule published, plans to issue ruling on price transparency

CDI Strategies - Volume 13, Issue 51

Despite successful legal challenges by stakeholders, hospitals will see continued cuts to the 340B drug savings program and reductions in reimbursements for off-campus clinic visits in 2020 under the calendar year (CY) 2020 outpatient prospective payment system (OPPS) final rule, HealthLeaders Media reported. The policy was vacated by a federal court in May but the final rule nevertheless includes 22.5% payment rate cuts for some drugs under the 340B program.

Overall, Medicare’s hospital reimbursement rates for hospital outpatient services will increase by a net 2.6% in 2020, compared with 2019.

Additionally, CMS continued with the second year of a two-year phase-in of site-neutral cuts— even though a federal court vacated the policy in September. CMS says the cuts will save Medicare about $800 million in 2020. The agency also expects to pass those savings along to Medicare beneficiaries reducing cost-sharing to $9, saving them about $14 for each off-campus clinic visit in 2020. CMS may appeal the September ruling but said it will ensure that 2019 claims for clinic visits will be paid consistent with the court order, HealthLeaders Media reported.

CMS said it will issue a separate final rule on its requirement that hospitals disclose payer-specific negotiated rates, which was proposed in the OPPS proposed rule.

Editor's note: To read HealthLeaders Media’s coverage of this story, click here. To read the final rule, click here.

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News, Outpatient CDI

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