Mid-Build Provider-Based Department (PBD) Attestation Filing Deadline Fast Approaching (Checklist Included)

Providers seeking to classify certain off-campus departments as “mid-build” for purposes of eligibility for Hospital Outpatient Prospective Payment System (OPPS) reimbursement must file a provider-based attestation with their Medicare Administrative Contractor (MAC) for receipt no later than February 13, 2017.

Changes to the OPPS reimbursement framework effective in 2016 essentially disqualified off-campus hospital departments that were not providing OPPS-covered services prior to November 2, 2015 from receiving payment under the OPPS. Many providers had commented on the proposed rule, noting that off-campus projects that were underway, but not yet operational, as of November 2, 2015 were planned in reliance on the existing OPPS reimbursement rule and would be unfairly financially disadvantaged under the new rule. Observers were hopeful that the Centers for Medicare and Medicaid Services (CMS) would include a “mid-build” exception in the final rule, allowing those off-campus projects that were “mid-build” as of November 2, 2015 to qualify for OPPS reimbursement even if they were not providing services as of that date. However, the final rule, published on November 14, 2016, did not contain an exception for “mid-build” projects. For more information on the final rule, please click here.

But good news for providers with “mid-build” off-campus departments was just around the corner. On December 13, 2016, the 21^st Century Cures Act (H.R. 34) was enacted into law. Section 16001 of the 21^st Century Cures Act excepts from the new OPPS rule off-campus facilities that were “mid-build” prior to November 2, 2015. The exception allows providers that meet certain specified requirements and file a provider-based attestation and certain additional documentation for receipt no later than February 13, 2017 to qualify for OPPS reimbursement for covered services furnished in a new off-campus facility on or after January 1, 2018, subject to a compliance audit to be completed no later than December 31, 2018.

The calculated receipt deadline for the requisite filings is Saturday, February 11, 2017. CMS has extended the deadline to the next business day, indicating that attestations and required supporting documentation must be received by the MAC no later than February 13, 2017. Facilities that comply with the “mid-build” exception will be eligible for OPPS reimbursement effective January 1, 2018.