In connection with CMS’s implementation of Section 603 of the Bipartisan Budget Act of 2015 (BBA15), which directs CMS to no longer pay hospitals the full OPPS rate for services furnished in non-excepted off-campus provider-based departments (PBDs) beginning January 1, 2017, CMS recently released an article (MLN Article) reminding providers that all off-campus PBDs are required to be correctly identified on a hospital’s enrollment record.  Under BBA15, off-campus PBDs that had been billing under the OPPS prior to November 2, 2015 are excepted, meaning that services provided at such locations will continue to be paid the OPPS rate.  Hospitals are strongly advised to add all excepted off-campus PBDs as practice locations on their CMS 855A enrollment form before the end of CY 2016 in order to ensure timely payment for services furnished at excepted PBDs.

In the preamble to the CY 2017 OPPS Final Rule implementing BBA15, CMS was unclear as to whether PBDs that had been billing under the OPPS prior to November 2, 2015 but were not included on a hospital’s enrollment record would be excepted.  The MLN Article specifies that “[i]f a hospital claim is submitted with a service facility location that was not included on the CMS 855A enrollment form, it will be returned to the provider until the CMS 855A enrollment form and claims processing system is updated” (emphasis added).  This statement suggests that if a provider has an off-campus PBD that is not listed on the hospital’s enrollment record but had been billing under the OPPS prior to November 2, 2015, CMS will pay for services performed at that location – but only after the provider makes the necessary changes to its enrollment record.  

Providers should review their enrollment records to ensure off-campus PBDs are included in their records and work with their Medicare Administrative Contractors to ensure any additional locations are added with the correct effective date (i.e., prior to November 2, 2015) if such location should be an excepted location.  The MLN Article is available here.