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CMS Releases the 2021 OPPS Final Rule

CMS Releases the 2021 OPPS Final Rule December 3, 2020

The 2021 Medicare Final Outpatient Prospective Payment System (OPPS) rule was released yesterday.  The provisions contained within the final rule will be effective on January 1.  The Final Rule adopts many of the changes included in the Proposed Rule including:   

  • Increase in hospital outpatient payment rates by 2.4% 
  • Elimination of the Inpatient Only (IPO) list over a 3-year period 
  • Continued 2-year exemption from certain medical review activities related to the 2-midnight rule for newly removed procedures from the IPO list
  • No change in payments for 340B drugs (rather than the proposed increase)
  • Creation of 2 new comprehensive APCs for urology and neurostimulator services
  • Expansion of covered ASC procedures
  • No changes to payment status indicators
  • Waiver of the 30-day and 60-day delayed effective date for the final rule due to the COVID-19 PHE

We recommend you read the entire Final Rule in order to identify all of the changes applicable to your facility.  

The Final Rule is available here: https://www.cms.gov/files/document/12220-opps-final-rule-cms-1736-fc.pdf

The fact sheet is available at: https://www.cms.gov/newsroom/fact-sheets/cy-2021-medicare-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center-0 HBE’s team of coding and compliance experts is available to assist you with implementation preparation, design and review of documentation templates, providing customized education and training for your staff , as well as auditing and monitoring,. We are also available to provide assistance with conducting risk assessments, internal investigations, charge description master reviews and policy and procedure development.

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