Emily Cook discusses CMS’s final OPPS rule, off-campus provider-based requirements, and 340B payment cuts with Report on Medicare Compliance

In a recent Report on Medicare Compliance article, Emily Cook discusses what hospitals need to know about the new off-campus provider-based department (PBD) requirements and the 340B payment cut in CMS’s final 2027 outpatient prospective payment system (OPPS) rule.

On PBDs, Emily noted that many hospitals don’t yet know what it takes to comply with the provider-based rules, and she welcomed CMS’s surprise decision to let hospitals open new PBDs after January 1, 2028. She pointed out a catch-22 in the process, since hospitals must bill Medicare before attesting but can’t bill without an attestation, and expects CMS to address it in forthcoming guidance. She also said CMS’s planned audits of PBD attestations could range from automated checks, such as a PBD’s distance from its main hospital, to more intensive document reviews and site visits.

Emily and partner Sandra DiVarco are both seeing a wide range of noncompliance as they help PBDs review and improve their compliance. One common problem is the public awareness requirement, which calls for signage that names the associated hospital rather than only the PBD or health system brand. Emily noted that replacing signs can be costly and time-consuming.

On 340B, Emily said CMS pared back its proposed cut to drug reimbursement, but that it remains significant. She expects hospitals to challenge it in court, as they successfully did when CMS tried to cut 340B payments in 2018.