Site-Neutral Payment
Medicare payment policy that pays the same amount for a service regardless of whether it is delivered in a hospital outpatient department, ASC, or physician office.
Definition
Site-neutral payment is the policy principle, partially implemented by Medicare since the Bipartisan Budget Act of 2015 (Section 603), that the same outpatient service should be reimbursed at the same rate regardless of setting. Section 603 made off-campus hospital outpatient departments established after November 2, 2015 paid at the lower Medicare Physician Fee Schedule equivalent rate, not the higher OPPS rate. Multiple subsequent legislative proposals would extend site-neutral payment more broadly.What this means in practice
Site-neutral expansion is one of the largest swing factors for hospital outpatient economics and for the ASC migration trend; MedTech teams must model both scenarios in their reimbursement analysis.- •Building a launch case on HOPD rates without modeling site-neutral expansion risk.
Related terms
Grouped by themeEditor's picks
· Hand-selected related conceptsMigration of procedures from hospitals to ambulatory surgery centers.
Medicare's payment system for physician professional services.
Medicare's payment system for hospital outpatient services.
More in Reimbursement
· Same categoryFederal program providing discounted drugs to safety-net providers.
The Medicare grouping system that determines hospital outpatient payment amounts under OPPS, analogous to MS-DRGs for inpatient.
Financial model that estimates the total cost consequences of adopting a new technology to a payer's budget over a defined horizon.
Single payment that covers all services for an episode of care.
Primary references
3 sources- 1
CMS, Site-Neutral PaymentsVerifiedCMScms.gov
- 2
42 USC 1395l, Payment for outpatient hospital servicesVerifiedCornell LIIlaw.cornell.edu
- 3
AMA CPT ResourcesVerifiedAMAama-assn.org
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