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Site-neutral payment provision a potential win for physician practices

Physician Practice Insider, July 12, 2016

The site-neutral payment provision in CMS’ 2017 OPPS proposed rule could level the playing field for independent physician practices, the American Medical Association (AMA) said.

CMS is proposing to implement Section 603 of the Bipartisan Budget Act of 2015, which requires the agency to stop allowing hospitals to bill certain services at off-campus provider-based departments under the higher OPPS payment rates. CMS proposed to pay the performing/supervising physician the nonfacility or office Medicare Physician Fee Schedule (MPFS) amount. Hospitals would not be able to bill on a UB-04 form or receive OPPS payment for services at off-campus provider-based departments for 2017. CMS says it is exploring other options for 2018.

Although hospitals have slammed this section of the proposed rule, independent physician practices may see the odds turning in their favor. Making similar payments for similar services regardless of the facility’s ownership will reduce incentives for hospitals to buy up physician practices and consolidate health services in an area under a single entity, the AMA said. And by creating a more level economic playing field, the proposed rule could give physician practices the edge they need to remain competitive and independent.

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