February 6, 2023

Volume XIII, Number 37

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February 03, 2023

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OPPS Provider-Based Final Rule— A More Practical Approach From CMS

CMS recently finalized sweeping changes to the way Medicare pays hospitals for services furnished in "new" off-campus provider-based departments (referred to as "off-campus PBDs").

CMS revealed the changes on November 1 with the publication of the CY 2017 OPPS Final Rule (the "Final Rule"), which implements Section 603 of the BBA. Section 603 included revisions to payment for off-campus PBDs developed on or after November 2, 2015.  Section 603 is discussed on pages 79699 – 79729.

While rulemaking is constrained by the requirements of Section 603, CMS seems to have heard the concerns of stakeholders and has reversed course on a number of problematic proposals contained in its Proposed Rule.

© Polsinelli PC, Polsinelli LLP in CaliforniaNational Law Review, Volume VI, Number 334

About this Author

R. Ross Burris III, Polsinelli PC, Health care Compliance, Attorney, Medical Billing Audits Lawyer

Ross Burris benefits clients by applying a strong business acumen to understanding the goals and challenges clients face, and by leveraging a commanding ability to counsel on intricate legal matters. His experience includes advising clients regarding the complex and ever-changing federal and state regulatory environment. Ross approaches each issue with a practical application that is unique to the client’s context, and draws on a strong background of working with numerous regional and national healthcare providers, including:

  • Hospitals...


Colleen Faddick's practice includes advising clients regarding the structure of and relationships among health care providers and entities within the complex federal and state regulatory environment. Colleen focuses on Medicare and Medicaid reimbursement and enrollment issues and appeals, fraud and abuse and self-referral law issues, licensing and certification of health care entities, clinical trial compliance and agreements for sponsors and providers, medical device payment and manufacturer relationships with physicians. Colleen works with hospitals, large physician...

Lauren Z. Groebe, Polsinelli, HIPAA Compliance Attorney, Health Care Provider Lawyer

Lauren Groebe tackles client’s issues with a high level of commitment and enthusiasm every time. She brings a passion for the practice of health care law and a genuine interest in its business and compliance components.

With a master’s degree in health administration and a Health Law Certificate from St. Louis University, Lauren understands the numerous changes and ongoing issues facing health care providers from a variety of perspectives. Lauren works with clients on operational, compliance, and regulatory issues with a focus on the 340B...

Bragg E. Hemme, Polsinelli PC, Medical Licensure Lawyer, State Hospital Regulatory Attorney

In order to assist health care clients address their targeted business concerns, Bragg Hemme draws on a wealth of practical experience and a solid understanding of the industry gained during her time as both external and internal counsel. Her experience includes advising clients regarding the complex and ever-changing federal and state regulatory environment. She focuses her practice on government payer concerns such as:

  • Medicare, Medicare advantage and Medicaid reimbursement

  • Enrollment issues and...

Sarah Kocher, Polsinelli Law Firm, Healthcare Attorney

Sarah Kocher enjoys helping clients navigate the highly regulated field of health care. She works with health care providers and others across the industry on an array of compliance matters, including:


  • Health care fraud and abuse

  • Medical staff issues

  • Reimbursement

While in law school, Sarah was on the first place team in the 2012 National Transactional Health Law Competition and was...