Reimbursement and Payment Methodologies

The October 2019 OPPS quarterly update reassigned certain injections from non-payable to separately payable. CMS also revised the status indicators for several recently approved advanced diagnostic laboratory tests.

CMS’ Hospital Outpatient Payment (HOP) panel made numerous recommendations at its annual meeting August 19 for the agency to consider ahead of the release of the 2020 OPPS final rule—with the panel and other stakeholders urging CMS to be more transparent with its responses and release of data.

CMS released the fiscal year (FY) 2020 IPPS final rule on August 2, increasing inpatient operating payment rates by 3.1%, significantly altering rural health payments, and expediting opportunities to pay for new technologies. Policy updates affect approximately 3,300 acute care hospitals and apply to discharges occurring on and after October 1.

CMS released the 2020 OPPS proposed rule July 29, proposing to refine previous policies related to price transparency and the 2-midnight rule, moving forward with year two of the site-neutral payment policy for clinic visits, while also asking for comments on how to potentially undo its policy that reduced payments for drugs purchased under the 340B drug discount program by nearly 30%.

Learn how to make the connections that will lead you to revenue integrity success with this issue of the quarterly NAHRI Journal.

Put CMS’ proposed changes in perspective to see the bigger picture.

Learn what you need to do now to ensure seamless Appropriate Use Criteria reporting.

Take a look at how the Appropriate Use Criteria Program applies to different types of facilities and in different settings.

Consider the potential impact of future appropriate use criteria changes including prior authorization.