Healthcare is an ever-changing entity – so it’s no wonder hospitals can encounter difficulty with keeping aware of reimbursement updates, especially while enduring a pandemic and all of its challenges to our industry over the last 18 months!  If you didn’t get a chance to read the 700+ page Federal Register, the summary below includes a list of the Top 10 inpatient, outpatient, and ASC reimbursement changes that you need to know:

Inpatient Final Payment Updates

    1. The market basket update is 2.7% for acute care hospitals; however, hospitals will only see a net increase of 2.5% in overall operating payment rates due to adjustments.
    2. Given the pandemic’s impact on healthcare facilities, CMS did little to disrupt the inpatient payment landscape by making only minor changes to DRG relative weights and DRG length of stay benchmarks.
    3. There were no MS-DRG numbering additions/deletions within the cardiovascular service line.
    4. There were 42 new procedure codes within cardiovascular procedures, 9 of which are specific to new technology. Over half of the new technology procedures use computer-aided mechanical aspiration devices from Penumbra, Inc.
    5. Various modifications were made to the quality-based adjustments (e.g., readmissions, value-based purchasing, and hospital-acquired conditions) due to the COVID-19 public health emergency.

Outpatient and ASC Proposed Payment Updates

    1. Overall, hospital-based outpatient payments will increase 2.3%.
    2. Modifications to the price transparency requirement increased the civil monetary penalty from $300 per day to $10 per bed per day if a hospital’s bed count is greater than 30. This is a maximum total penalty amount of $2,007,500.
    3. CMS will halt the elimination of the inpatient-only list and add the 298 procedures back onto the list (these were removed in the CY21 rule).
    4. For the ASC-covered procedure list, CMS will revert back to the long-standing patient safety criteria methodology and remove 258 of the 267 procedures that we added in the CY21 rule. While impactful to the ASC industry, the most common cardiovascular procedures remain on the “covered” procedure list.
    5. The final rulings go into effect October 1, 2021 for the inpatient payment system and we expect the final outpatient ruling in early November with a January 1, 2022 effective date.

For more information on what these changes mean to your program, or to obtain a summary “cheat sheet” of these and other changes to the IPPS and OPPS for the coming year, give us a call at 412-364-8200. Understanding the impact of these adjustments to your programs’ finances is the first step to optimizing reimbursement and also identifying any clinical and operational opportunities for positive change.