Issue link: http://viewer.e-digitaledition.com/i/620826
T HE T R EMOR C AUSED by President Obama's signing of the Bipartisan Budget Act of 2015 on Nov. 2 could be felt by ož-campus hospital outpatient departments for miles. Section 603 of the Act significantly changes how Medicare will pay for items and services furnished at hospital ož-campus out- patient departments. Currently, ož-campus clinics operating as provider-based hos- pital outpatient departments are reimbursed under Medicare's outpatient prospective payment system (OPPS), which generally results in higher reimbursement (because it pays both a facility fee and a professional fee) than what Medicare pays to freestand- ing clinics and o³ces for the same service. The rationale for higher reimbursement is to compensate ož-campus facilities for additional costs related to their operating as an outpatient department of the main hospital. That is about to change. Beginning Jan. 1, 2017, services and items furnished at ož-campus provider-based outpatient departments will no longer be reimbursed under OPPS for non-emergency services. Instead, they will be paid under the Medicare Physician Fee Schedule or the Ambulatory Surgery Center Fee Schedule. The intent is to reduce Medicare spending. The Act does carve out several exceptions. For example, ož-campus hospital provider-based outpatient departments operating and billing under OPPS before Nov. 2, 2015, will be grandfathered and permitted to continue billing under OPPS after the Jan. 1, 2017, enactment date. Hospital ož-campus outpatient departments currently under development, but not yet billing under OPPS, however, will not be exempted from the Act. Also, the Act only applies to ož-campus hospital outpatient departments that are located more than 250 yards from the hospital's main campus. Current Medicare regulations define campus as the "physical area immediately adjacent to the provider's main buildings and other areas and structures that are not strictly contiguous to the main buildings but are located within 250 yards of the main buildings." New hospital outpatient departments located on or within 250 yards of the hospital's main campus will be permitted to bill under OPPS. Similarly, facilities within 250 yards of a "remote location of a hospital" will be eligible to bill under OPPS as a provider- based outpatient department. A "remote location of a hospital" is a facility "furnishing inpatient hospital services under the name, ownership, and financial and administrative control of the main [hospital] provider." Ož-campus "dedicated emergency departments" also will be permitted to receive provider-based reimbursement. Centers for Medicare & Medicaid Services likely will issue regulations providing future guidance to this fundamental change that undoubtedly will curtail the creation of new hospital ož-campus provider-based outpatient departments. Joe Feltes is an attorney with Buckingham , Doolittle & Burroughs in Canton and a member of its Health & Medicine Practice Group. He is also the managing partner of Buckingham Canton. For more information about the law firm, go to bdblaw.com or e-mail Feltes at JFeltes@BDBLAW.com. ■ New Provider Base Rules Impact Off- Campus Hospital Outpatient Departments BY JOSEPH J. FELTES, JD 2 4