According to a CMS fact sheet, the agency estimates that the change, implemented over a 2-year period, will save an estimated $380 million in 2019 alone. CMS is doing away with the current system that pays so-called 'off-campus' hospital-owned facilities an estimated $75 to $85 more than it does independent counterparts for this service. Currently, Medicare and beneficiaries often pay more for the same type of clinic visit in the hospital outpatient setting than in the physician office setting. Outpatient Prospective Payment System (OPPS)Īs it proposed, CMS will expand the use of a 'site-neutral' payment model in its reimbursement for the clinic visit service (HCPCS G0463), the most common service billed under the OPPS. As it continues to roll out final payment rules for 2019, the US Centers for Medicare and Medicaid Services (CMS) is sticking to its pattern of mostly following through on its original proposals-this time by ending payment rates that favor hospital-owned outpatient facilities over independent physicians' offices, and adopting a new supplier bidding system for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).

Medicare outpatient neutral site visits