Reimbursement and Payment Methodologies

CMS will begin reprocessing 2019 claims for some services rendered at excepted off-campus provider-based departments. The affected claims are for services represented by HCPCS code G0463 (hospital outpatient clinic visit for assessment and management of a patient) with dates of service between January 1, 2019, and December 31, 2019.

Successfully responding to payer charge audits for services billed above room and bed rate can be a challenge. The Cleveland Clinic contracting, compliance, and revenue cycle departments worked together on a project to address this focus. 

Speakers and registrants shared tips and insights into revenue integrity hot topics on day one of the 2021 Revenue Integrity Symposium, held virtually August 17–18.

CMS released the fiscal year (FY) 2022 IPPS final rule on Monday, August 2, which finalizes its efforts to cushion the ongoing impact of the COVID-19 pandemic on hospital revenue and resources. Along with payment rate updates, the final rule also repealed the MS-DRG relative weight methodology and hospital cost-reporting requirement finalized in the 2021 IPPS final rule.

Less than a year after CMS finalized the three-year phaseout of the inpatient-only (IPO) list to be completed by 2024, the agency is looking to reverse course, according to the 2022 OPPS proposed rule, released Monday, July 19.

CMS is proposing a 4% decrease to the Medicare conversion factor, permanent expansion of telehealth coverage for some mental health services, and new timelines for Appropriate Use Criteria (AUC) reporting, according to the 2022 Medicare Physician Fee Schedule (MPFS) proposed rule.

Reach the next level of revenue integrity

Take a closer look at how CMS’ proposed changes could transform hospital reimbursement.

Review proposed code updates from the fiscal year 2022 Inpatient Prospective Payment System proposed rule.