Elevance Moves to Curb Hospital Billing for Off-Campus Care
Elevance Health is implementing a policy to restrict hospitals from charging facility fees or higher reimbursement rates for services delivered at off-campus outpatient departments, aiming to align payment with site-neutral principles. Hospital groups oppose the move, arguing the reimbursement reductions could jeopardize patient access to care, particularly in markets where hospital-owned outpatient clinics are prevalent. The policy affects hospitals and health systems contracted with Elevance across its commercial and potentially Medicaid managed care lines. Details on effective dates and scope across Elevance's state Medicaid contracts were not specified.
Hospitals and health systems contracting with Elevance's Medicaid managed care plans face reduced reimbursement for off-campus outpatient services, pressuring revenue and potentially prompting access and network-adequacy disputes.
Managed Care · Finance
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