Preventing Medicare Overbilling: Site-Neutral Payments for Off-Campus Hospital Services.
This Act aims to reduce healthcare costs for Medicare beneficiaries by enforcing site-neutral payment policies for hospital services. Starting January 1, 2026, off-campus hospital departments must use separate unique identifiers (NPIs) when billing, preventing them from charging higher hospital rates for standard outpatient services. This change promotes billing transparency and is expected to lower expenditures for Medicare and potentially reduce out-of-pocket costs for citizens.
Key points
Site-Neutral Payments: Promotes equal payment rates for the same services, regardless of whether they are provided at the main hospital campus or an off-campus outpatient department.
Separate Identifiers Required: Effective January 1, 2026, off-campus outpatient departments must be assigned a separate unique health identifier (NPI) distinct from the main hospital.
Mandatory Billing Changes: Hospitals must use the off-campus department's unique identifier when billing Medicare and private insurers, ensuring accurate and transparent claims submission.
Eliminating Billing Exceptions: The Act removes certain exceptions that previously allowed off-campus locations, including some emergency departments, to bill at higher hospital rates.
Introduced
Citizen Poll