2022 OPPS final rule doubles down on price transparency penalties

Wednesday, November 3, 2021

The 2022 Outpatient Prospective Payment System (OPPS) final rule, released November 2, finalizes major changes to enforcement of CMS’ hospital price transparency requirements, among other changes.

Price transparency

Following a JAMA Internal Medicine study released in June that found 75% of the country’s 100 highest-revenue hospitals noncompliant with at least one of the major requirements of CMS’ price transparency policy, the agency proposed reforms in the 2022 OPPS proposed rule to increase compliance.

CMS is moving ahead with the increased, tiered system of monetary penalties for noncompliance with price transparency requirements. The scaled approach aims to put pressure on larger organizations while maintaining the current penalties for smaller organizations.

For hospitals with 30 or fewer beds, the minimum monetary penalty is $300 per day of noncompliance. For hospitals with more than 30 beds, the agency will add $10 per day per bed, up to a maximum of $5,500 per day. Using this methodology, one full calendar year of noncompliance will cost a minimum of $109,500 per hospital and a maximum of $2,007,500 per hospital.

IPO list

CMS is halting the elimination of the inpatient-only (IPO) list, citing safety concerns. In addition, after a review of the nearly 300 services removed from the IPO list in 2021, CMS is adding all but a few back to the list.

Other changes in the final rule include changes to quality reporting, updates to pass-through device payments, and more.

Most provisions of the final rule are effective January 1, 2022. Revenue integrity professionals should thoroughly review the final rule, ensure chargemasters and other systems are updated as needed, and coordinate staff training on the changes.

Editor’s note: For more detailed analysis of the final rule, sign up for the webinar “2022 OPPS Final Rule: Implementing the Latest CMS Changes.” NAHRI members can also register for our January 2022 Quarterly Call for a roundtable discussion of the rule featuring NAHRI Advisory Board members.

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