Providers Urge Stakeholders to Weigh in on CMS’ Site-neutral Payment Proposals

CMS did not have a choice about implementing site-neutral payment policies after Congress passed Section 603 of the Bipartisan Budget Act of 2015, but providers hope the agency will reconsider some of the provisions to operationalize the policy introduced in the 2017 OPPS proposed rule.

While CMS’ makeshift billing policy is likely to be the most immediately challenging provision for facilities, stakeholders need to consider the long-term ramifications of the remaining proposals, according to members of the Provider Roundtable (PRT), a nationwide group of healthcare representatives that regularly presents written comments and oral testimony to CMS regarding regulatory and policy issues.

“It’s important for providers to understand that although they may not believe their legacy off-campus, provider-based departments [PBDs] will be impacted, the proposed rule contains significantly limiting provisions related to expansion of services and relocation,” says PRT member John D. Settlemyer, MBA, MHA, CPC, assistant vice president of corporate revenue management/CDM support, for Carolinas HealthCare System of Charlotte, North Carolina.

Off-campus PBDs built and billing before November 2, 2015—when the Bipartisan Budget Act was passed—would retain what CMS calls “excepted” status and continue billing under the OPPS—for now. The agency proposes that a change in ownership would not remove an off-campus PBD’s excepted status as long as the new owner assumes the same provider agreement, but a change in location would.

The agency is specifically requesting comments on this provision and whether certain exceptions should apply for situations beyond a hospital’s control, such as a natural disaster.

Another limiting factor for providers is that off-campus PBDs that expand services beyond those offered and billed before November 2, 2015, will not be allowed to bill them under the OPPS. CMS has proposed clinical families based on APCs that would determine whether those expanded services would continue to be excepted (see Table 21 on page 342 of the proposed rule).

CMS needs to hear from providers that linking expansion to services provided through APC clinical families will cause a host of problems, and seems to go far beyond Congress’ intent of creating site-neutral payment policy, says Jugna Shah, MPH, president and founder of Nimitt Consulting.

“If finalized, all providers with off-campus provider-based clinics and departments will be impacted one way or another by this policy, whether it’s today or over time," says Shah.

One of the most important comments providers can make to CMS is that they must be allowed to continue reporting their services to CMS on a UB04/837I form consistent with the Administrative Simplification Act and requirements for institutional claims, rather than on a CMS-1500 form.

The task of commenting doesn't necessarily have to be time- or labor-intensive, says Shah.

“What’s critical is that providers weigh in and explain to CMS why its proposals are simply not feasible, which the American Hospital Association (AHA) has helped outline in its draft letter,” she says. “The more providers who relate specific examples the better, but using the AHA template is a good starting point to help CMS understand all of the different concerns.”

In addition to specific comments, the volume of providers CMS hears from is important.

“Without an outcry from the provider community, CMS’ implementing proposals could go forward, which would impact providers immensely,” says Shah. “Now is the time for providers to take action by telling CMS what they think.”

Comments may be brief and to the point. What’s key is making data-driven arguments using specific scenarios and providing CMS with examples of operational, staffing, systems and process issues.

If you're planning on submitting comments electronically, consider the following:

• Type out your comments beforehand in a word processing program, then copy and paste as appropriate. This will make commenting easier and faster, and it can help ensure that you haven't omitted anything important.
• Forward your comments to your compliance and/or legal department for its review before submitting them to CMS.
• After you have everything typed out, uploading it is the easiest part. Visit www.regulations.gov and enter "2017 OPPS" in the search field. Select the appropriate link from the list of search results.
• Look for a link called Submit Comment above the name of the document. Click on this link, input the requested information, and click Submit. This completes the process and provides a tracking number for comments.

Comments are due to CMS by September 6 and a final rule is expected by November 1.