CMS reviewing mid-build exception denials

Alia Paavola - Friday, September 24th, 2021

CMS is reviewing its decision to deny a majority of requests by hospitals for a mid-build exception to the site-neutral payment policy. 

In January, CMS rejected more than 60 percent of hospitals' applications for the mid-build exceptions. Since the determination, the American Hospital Association has urged CMS to rescind the application denials and to establish a review process to correct errors. 

The AHA said the denials "inappropriately reduced payment rates for items and services furnished by certain off-campus provider-based departments that first billed Medicare for services furnished on or after Nov. 2, 2015."

CMS said it will reevaluate hospitals' applications for exceptions from reimbursement cuts to their off-campus outpatient facilities out of an abundance of caution and in response to questions raised by providers about its audit decisions.

"CMS will review each previously failing provider's audit findings for compliance with statutory requirements and for accuracy and completeness," the agency said.

CMS also will accept additional documentation from providers to support their mid-build exception requests. The documents are due Oct. 10.

The Bipartisan Budget Act of 2015 altered the way off-campus, provider-based departments were reimbursed. The payments were made site neutral by reducing the payment rate for services provided at off-campus, provider-based departments. At the urging of provider groups, The 21st Century Cures Act established exceptions for certain off-campus hospital outpatient departments that were under construction, or "mid-build," at the time the Bipartisan Budget Act of 2015 was passed.