Health: Medicare Payments by Place of Service
Year Identified: 2016
Area Number: 30
Area Type: Cost Savings & Revenue Enhancement
◐- Partially Addressed
○- Not Addressed
◉- Consolidated or Other
⊘- Closed-Partially Addressed
⊗- Closed-Not Addressed
Last Updated:March 1, 2017
Congress should consider directing the Secretary of Health and Human Services to equalize payment rates between settings for evaluation and management office visits—and other services that the Secretary deems appropriate—and return the associated savings to the Medicare program.
As of March 2017, no legislative action identified. While Congress enacted legislation in November 2015 to exclude services furnished by off-campus hospital outpatient departments from higher payment—effective January 1, 2017—this exclusion will not apply to services furnished by providers billing as hospital outpatient departments prior to legislation being enacted. All providers billing as hospital outpatients during GAO’s study (issued in December 2015) would continue to be paid under the higher rate. In addition, the exclusion will not apply to services provided by on-campus hospital outpatient departments. Until such action is taken to equalize payment rates Medicare pays for certain health care services, as GAO suggested in December 2015, Medicare and beneficiaries could continue to pay more for the same health care service depending on where the service is performed.