On Jan. 15, the U.S. Department of Health and Human Services announced it will be recouping payments made for outpatient clinic visit services provided at off-campus hospital outpatient departments (HOPDs).
The announcement comes in response to a federal appeals court decision from July 2020 which reversed a previous court decision that had sided with hospitals.
As covered in a previous edition of The Valued Voice, the issue stems from the 2019 Outpatient Prospective Payment System (OPPS) Rule which cut payments to off-campus HOPDs for clinic visit services. The Wisconsin Hospital Association (WHA) made this a priority advocacy issue, enlisting support from members of Wisconsin’s congressional delegation in a 2018 letter to the Centers for Medicare & Medicaid Services (CMS) expressing concern over the policy. After the 2019 OPPS rule took effect, hospital groups filed a lawsuit challenging that CMS had overstepped its statutory authority in making the cuts and gone against the specific wishes of Congress. A federal court agreed, and CMS reprocessed claims to impacted hospitals beginning in early 2020. With the appeals court reversing this decision last summer, CMS announced it will now be recouping those payments beginning in July of this year.
Meanwhile, the American Hospital Association has said it intends to bring this case to the U.S. Supreme Court, hoping that it will be more willing to rule on the merits of the case, given its new more conservative makeup. The previous decision cited precedence from a 1984 court case giving federal agencies wide deference on interpreting statutes.
Contact WHA Vice President of Federal and State Relations Jon Hoelter for more information.