CMS released the 2023 Proposed Inpatient Prospective Payment Rule.  The 1,786 page document includes some major changes for the upcoming year including:

• 3.2% increase in operating payments for acute care hospitals
  • Individual hospitals may receive reductions for excessive readmissions
  • Individual hospitals may receive a 1% reduction for poor quality performance
  • Individual hospitals may receive additional positive or negative adjustments based on the Value-Based Purchasing Program
• Addition of 1,176 ICD-10 diagnosis codes
• Addition of 45 ICD-10 procedure codes
• Reclassifying almost 300 ICD-10 diagnosis codes as invalid
• Addition of more than 150 ICD-10 diagnosis codes to the CC and MCC lists
• Removal of approximately 20 ICD-10 diagnosis codes from the CC and MCC lists
• There will be no changes to the number of MS-DRGs (currently 767) however, CMS is testing MS-DRG grouper, version 40, which includes testing of proposed new methodologies for calculating weights and payments.
• New provisions for the Hospital Inpatient Quality-Reporting Program
• New provisions related to the Interoperability Program

We recommend reviewing the proposed changes in their entirety now and begin preparing for necessary updates and start the education and training process for your clinical and administrative staff.  Providers are going to be facing an exceptionally large number of changes in the upcoming year with the anticipated next wave of overhaul for evaluation and management services as well as the mandatory implementation for time based documentation and billing for split/shared services in addition to the above changes.

The HBE experts are available to assist your organization with effective implementation of all of these important changes.

The Proposed Rule may be found here: https://public-inspection.federalregister.gov/2022-08268.pdf

The addenda may be found here: https://www.cms.gov/medicare/acute-inpatient-pps/fy-2023-ipps-proposed-rule-home-page#Rule

The fact sheet may be found here: https://www.cms.gov/newsroom/fact-sheets/fy-2023-hospital-inpatient-prospective-payment-system-ipps-and-long-term-care-hospitals-ltch-pps

 HBE’s team of experts is also available to assist you with routine auditing and monitoring, policy and procedure development as well as customized education and training for your clinical and administrative staff.

DISCLAIMER:  This newsletter contains 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.