2022 OPPS Final Rule

CMS released the 2022 Final OPPS rule yesterday.  

The 1,394 page Final Rule contains a number of notable items including:

  • CMS will not eliminate the inpatient only (IPO) rule 
  • Addition of 298 services back to the IPO list that were removed in 2021
  • Increase in hospital outpatient payment rates by 2.0% 
  • Increase ASC payment rates by 2.0% for ASCs that meet quality reporting requirements
  • 2% reduction in payments for hospitals that fail to meet reporting requirements
  • Required hospital transparency policy changes including an increase in the amount of penalties for noncompliance
    • Minimum penalty of $300 per day for hospitals with a bed count of 30 of fewer
    • Penalty of $10 per day for hospitals with a bed count of more than 30, not to exceed a maximum daily amount of $5,500
    • Annual minimum penalty for non-compliance of $109,500 per hospital
    • Annual maximum penalty for non-compliance $2,007,500 per hospital
  • No changes in OPPS payment policies for clinic, emergency department hospital outpatient visits and critical care services
  • Change in APC assignment for certain procedure codes
  • Exemptions to the 2 times rule that include certain skin procedures, imaging, radiation therapy among others
  • Changes to the list of ASC covered surgical procedures
  • Continued 2-year exemption from certain medical review activities related to the 2-midnight rule for procedures eliminated from the IPO list in 2021
  • CMS is seeking comment on COVID-19 flexibilities and whether certain policies should remain permanent
  • No changes to payment status indicators

We recommend you read the entire Final Rule in order to identify all of the changes applicable to your facility.  The HBE team is available to assist you with the implementation of these important changes as well as provide assistance in preparing your staff through education and training. 

The Final Rule is available here:   https://public-inspection.federalregister.gov/2021-24011.pdf

The Final Rule Fact Sheet is available at: https://www.cms.gov/newsroom/press-releases/cms-oppsasc-final-rule-increases-price-transparency-patient-safety-and-access-quality-care

HBE’s team of coding and compliance experts is available to assist you with external reviews of your documentation, coding and reimbursement as well as providing customized education and training for your staff. We are also available to provide assistance with conducting risk assessments, internal investigations and policy and procedure development.

DISCLAIMER:  This newsletter only summary information and highlights; it should be read in conjunction with the full article or document provided as a link.  Any advice or recommendations are general and specific questions should be directed to professional counsel.

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