CMS is considering alternatives to established practice for setting payment rates in the fiscal year (FY) 2022 Inpatient Prospective Payment System (IPPS) proposed rule. The agency cites the need to address changes in hospital utilization due to the COVID-19 pandemic, but its proposal raises questions about future rate-setting and how to account for the ongoing impact of COVID-19.
The fiscal year (FY) 2022 Inpatient Prospective Payment System (IPPS) proposed rule makes broad efforts to cushion the ongoing impact of the COVID-19 pandemic on hospital revenue and resources. The proposed rule, released April 27, also eliminates sweeping changes to MS-DRG rate-setting finalized in the 2021 IPPS final rule.
CMS will begin reprocessing 2019 claims for certain services rendered at excepted off-campus provider-based departments (PBD), the agency announced. The affected claims are for services represented by HCPCS code G0463 (hospital outpatient clinic visit for assessment and management of a patient). Starting July 1, CMS will reprocess these claims to pay them at the same rate as non-excepted off-campus PBDs, or 70% of the 2019 Outpatient Prospective Payment System (OPPS) rate.
A federal appeals court on December 29 rejected the hospital industry’s attempt to block CMS’ price transparency rule, effective January 1, that requires hospitals to disclose standard charges, including payer-specific negotiated rates, for 300 services.
