2020 OPPS/ASC Payment System Proposal Includes ‘Site Neutral’ Payments and New ASC Covered Procedures

Last Updated: Aug 8, 2019

Outpatient-clinicThe Centers for Medicare and Medicaid Services (CMS) has issued its proposal for the 2020 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgery Center (ASC) Payment System .

CMS plans to continue its two-year phase-in of “site neutral” payments in order to reduce the difference between Medicare payments for visits to off-campus hospital outpatient departments and visits within the physician office setting. “In total, the policy is estimated to save $160 million for beneficiaries by lowering their copayments and save the Medicare program an estimated $650 million in 2020,” CMS says.

Additional provisions in the OPPS/ASC Payment System proposed rule include:

  • Expanding the number of ASC covered procedures to include knee replacements and additional cardiac procedures – CMS is proposing to add the following procedures to the ASC covered procedures list: total knee arthroplasty (knee replacement); knee mosaicplasty; percutaneous transluminal coronary angioplasty; percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; and percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed
  • Adding Price Transparency – The proposal would require hospitals to make their standard charges (i.e. gross charges and payer-specific negotiated charges) for all items and services provided by the hospital. To enforce this requirement, CMS is proposing monitoring, auditing, corrective action plans, and civil monetary penalties of $300 per day.
  • Updating OPPS and ASC payment rates – CMS is proposing to update both OPPS and ASC payment rates by 2.7 percent.
  • Removing total hip arthroplasty (hip replacement) from the inpatient-only list – The proposal includes a provision to make hip replacement surgery eligible to be paid by Medicare in both the hospital inpatient and outpatient setting.
  • Assisting rural hospitals by addressing wage index disparities – CMS is proposing changes to the wage index calculation, including a methodology to increase the wage index for certain low wage index hospitals, and to change how the statutory rural floor wage index values are calculated. 

CMS offers more information on the OPPS/ASC Payment System proposal in this online fact sheet. A PDF version of the proposal is available online here.

Public comments on the proposed rule will be accepted through Sept. 27, 2019. An online comment form is available via regulations.gov here.

Leave a comment

Norcal Mutual

Learn More