Providers Question the Need
to Submit Attestations

A growing number of providers are questioning the need to submit attestations after the CMS reduced the payment for excepted (grandfathered) off-campus provider-based clinics to the Medicare Physician Fee Schedule (MPFS) rate. 
 
Starting January 1, 2020, and over the following months, the Medicare Administrative Contractors will automatically reprocess claims paid at the reduced rate; no provider action needed.
 
For those of you that have not heard, the Court has ordered the CMS to cease this payment reduction and reprocess claims back to January 1, 2019. 
 
The CMS installed a revised Hospital Outpatient Prospective Payment System Pricer to update the rates being applied to claim lines. The revised Pricer went into production on November 4, 2019, and applies to claims with a line item date of service of January 1, 2019, and after.
 
The CMS will continue to target these clinics and one sure way for them to pay at a lower rate is to audit for compliance with the provider-based rules. Failure to comply would likely result in a payback to the CMS going back to the original effective date the clinic began billing as a provider-based department. This will cause the clinic to be ineligible to participate in the 340B drug discount program. 
The provider-based rules are not well published by the CMS and can be very confusing, causing providers to fall out of compliance with the regulations. Let Arnett Carbis Toothman LLP assist you with a provider-based compliance risk assessment and/or complete an attestation to obtain the CMS approval so that you do not fall out of compliance!