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
- 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.
- 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.
- 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.