Reimbursement and Payment Methodologies

The American Hospital Association (AHA) and the Association of American Medical Colleges (AAMC) recently filed a lawsuit against the Department of Health and Human Services (HHS) for continuing to reduce payments for hospital outpatient services provided in grandfathered, off-campus provider-based departments (PBD) in the fiscal year 2020 Outpatient Prospective Payment System final rule.

Face the changes and evolve with revenue integrity.

Understand how new policies and requirements will affect your organization.

Take a comprehensive look at the changes for this year.

Review E/M documentatin changes in the 2020 Medicare Physician Fee Schedule final rule.

Review changes to supervision in the 2020 Medicare Physician Fee Schedule final rule.

Learn how to establish revenue integrity best practices for Medicaid populations.

Take a look at federal Medicaid guidance and learn how to find guidance for your state's program.

CMS is automatically reprocessing 2019 hospital claims for certain services provided at grandfathered off-campus provider-based departments (PBD) after a federal judge vacated portions of the 2019 outpatient prospective payment system (OPPS) final rule. However, the agency has filed an appeal and the same federal judge declined to strike down cuts for those services planned for 2020.

As 2019 draws to a close, and as revenue integrity professionals and their organizations look to the future, an important set of decisions and changes await. Among the largest is that to come in 2021 when the new price transparency requirements for hospitals will be in place. CMS finalized the changes in the CY 2020 Hospital Outpatient Prospective Payment System (OPPS) Policy Changes: Price Transparency Requirements for Hospitals to Make Standard Charges Public final rule.