CMS Set to Repay 2019 Outpatient Payment Cut to OMC

CMS Set to Repay 2019 Outpatient Payment Cut to OMC

CMS Set to Repay 2019 Outpatient Payment Cut to OMC, Other Hospitals in Response to Lawsuit

Uncertainty of Legal Outcome, CMS Intent to Institute Additional Cuts in 2020 Remain

PORT ANGELES  (December 12, 2019) – Olympic Medical Center was informed that starting January 1 and over the next few months, Medicare administrative contractors will automatically reprocess calendar year 2019 claims for hospital outpatient services provided in off-campus provider-based departments in order to repay Olympic Medical for an unlawful payment cut that was successfully challenged by the American Hospital, Olympic Medical Center and other hospital organizations in court.

A federal judge in October reaffirmed her previous order to the Centers for Medicare and Medicaid Services (CMS) to vacate the payment cut, implemented in January of 2019.

“This is a huge win for our patients and for our community,” says Eric Lewis, chief executive officer, Olympic Medical. “We are very pleased that this site neutral policy has been reversed and Olympic Medical Center looks forward to expanding primary care and specialty care services for our patients.”

Medicare claims as of November 20, 2019 paid in full

Upon learning of CMS repayment for 2019 cuts, it was confirmed that Medicare claims paid by CMS as recently as November 20 were done so without the 30% cut.

“Seeing these claims come through from CMS as fully paid is exciting,” says Lewis. “However, it remains unclear to us if CMS intends to implement the additional 30% of cuts as intended in its CY 2020 rule. It also remains uncertain if CMS intends to file a notice of appeal to this rule.”

“We appreciate all the community support to help reverse this policy and we look forward to long term planning to expand our Sequim campus.” adds Lewis.