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CMS pitches 3 sweeping payment rules for 2020: 10 things to know

By August 6, 2019C&A Blog

CMS released three proposed rules on July 29, which include payment updates for outpatient and physician services and expanded price transparency initiatives.

Here are a couple of takeaways from the proposed rules:

Medicare Outpatient Prospective Payment System

  1. Payment update. CMS proposed increasing the OPPS payment rates by 2.7 percent in 2020 compared to 2019. The agency estimates total payments to OPPS providers will be roughly $6 billion higher in 2020 than this year.
  1. Price transparency. The proposed rule builds on previous price transparency guidance from CMS by defining “standard charges” to include the hospital’s gross charges and payer-specific negotiated rates for an item or service. Hospitals would be required to publish all standard charges online in a machine-readable file. In addition, the rule would require hospitals to publish payer-specific negotiated rates for 300 services consumers are likely to shop for, including 70 defined by CMS, in a searchable and consumer-friendly manner. Hospitals that fail to publish the prices could be fined up to $300 a day.
  2. Site-neutral payments. The proposed rule would finish phasing in a policy adopted last year to make payments for clinic visits site-neutral by reducing the payment rate for hospital outpatient clinic visits provided at off-campus provider-based departments. These off-campus departments would be paid at a rate of 40 percent of the OPPS rate in 2020.


Link:  https://www.beckershospitalreview.com/finance/cms-pitches-3-sweeping-payment-rules-for-2020-10-things-to-know.html


James Ballard

Author James Ballard

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