NAHRI Quarterly Call: 2022 OPPS final rule

Wednesday, February 16, 2022

NAHRI members caught up with association updates, news, and more on the January 25 NAHRI members-only Quarterly Call.

The call kicked off with NAHRI Director Nicole Votta discussing the latest NAHRI news.

The 2022 Revenue Integrity Symposium (RIS) will be held at the Hilton Phoenix Resort at the Peak in Phoenix, Arizona, September 19–20. As we reconnect, RIS provides crucial opportunities to engage with like-minded peers across the healthcare spectrum. The event will feature the top-level educational sessions, industry-leading experts, and networking opportunities attendees have come to expect from RIS.

NAHRI is also offering two virtual conferences in 2022.

Mastering Utilization Review and Patient Status: A NAHRI Virtual Event will be held virtually March 8–9. This event is your chance to brush up on the intersection of utilization review and revenue integrity and take a deeper dive into hot topics including inpatient-only list compliance, Medicare’s rules for observation services, Medicare Advantage and the 2-midnight rule, and more.

The Critical Access Hospital and Rural Health Clinics Reimbursement Virtual Symposium, to be held virtually April 12–13, will get you up to date on the latest revenue integrity strategies and solutions for these facilities. The event will give critical access hospital and rural health clinic teams the chance to learn from experts and brainstorm with their peers. Expert speakers will share tips for managing Medicare policies, optimize coding and documentation, and ensuring complete and compliant revenue.

Lastly, NAHRI is moving to a new testing partner for the CHRI exam, Prometric. Prometric allows examinees the option to take the CHRI exam at a computer-based testing center or via remote online proctoring.

2022 OPPS final rule: NAHRI Advisory Board roundtable

NAHRI Advisory Board members Ronald Hirsch, MD, FACP, CHCQM, Valerie Rinkle, MPA, CHRI, and John D. Settlemyer, MBA, MHA, CPC, CHRI, started off by discussing the 2022 Outpatient Prospective Payment System (OPPS) final rule, including updates to the inpatient-only list, telehealth, and price transparency.

“As revenue integrity people, you’re probably seeing things on the back end, but take the time to go to the front end and look to see how physicians are scheduling surgeries so you can find out whether or not they have to have a specific status order,” Hirsch explained. “Hospitals have a moral and ethical obligation to make sure that when patients are receiving medical care, it is clinically appropriate. We would hope that physicians would do that, but there needs to be some checks in place.”

If the surgery is not on the inpatient-only list, the 2-midnight rule must be applied for the status determination.

Rinkle then went on to discuss telehealth. For substance use disorders (SAD) and SADs with co-occurring mental health disorders or other mental health conditions, Congress expanded telehealth, allowing the home to remain an originating site for services.

The next topic was price transparency. To increase compliance with its price transparency requirements, CMS raised civil monetary penalties for hospitals not in compliance, and requirements for online price estimator tools were clarified.

Surprise billing was the next topic. There is no balance billing for out-of-network emergency services, non-emergency services by non-participating providers, or air ambulant services by non-participating providers. Also, for uninsured or self-pay individuals, a good faith estimate is required to be provided in advance of scheduled services.

A recording of the January Quarterly Call is available for NAHRI members. Listening to or presenting on Quarterly Calls awards one CHRI CEU. Register now for our 2022 series of calls. If you’d like to present on an upcoming call, please contact NAHRI at