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Proposed Changes to the Outpatient Prospective Payment System for 2022

By: Courtney Tesvich | July 28th, 2021

Proposed Changes to the Outpatient Prospective Payment System for 2022 Blog Feature

On July 19, 2021, the Centers for Medicare & Medicaid Services (CMS) released the 2022 proposed rule for the Outpatient Prospective Payment System (OPPS). These changes are meant to increase reimbursement rates for OPPS, implement increased penalties for price transparency violations and reverse changes to the inpatient-only list (among other things).

In this blog, we will take a brief look at some of the most significant proposed changes to the OPPS for 2022. For full details, readers should use this link.

OPPS Payment Rates Will Increase

Let’s start with the thing that is probably of the most interest to everyone—getting paid. There is good news on this front, as CM is proposing increasing the 2022 OPPS payment rates for hospitals as well as ASC payment system rates by 2.3 percent (over the 2021 reimbursement rates). According to CMS estimates, this would mean that total payments to OPP System providers would total $82.7 billion in 2022 (an increase of roughly $10.8 billion compared to 2021). Needless to say, this should be seen as good news for all OPP participants.

Penalties for Transparency Violations & a New Price-Hiding Code Ban

Now we move on to some of the not-so-fun stuff. At this point in time, everyone in healthcare needs to be aware that CMS are not backing down on price transparency, and there is no indication that they have any intentions on doing anything but expanding these rules. Private practices should be aware that the price transparency rules currently being implemented for hospitals are likely to expand to practices in the not-so-distant future.

For now, CMS is proposing an increase to the minimum fine for price transparency violations. The minimum fine for such violations could now be up to $2 million per year. Specifically, hospitals with more than 30 beds that are found to be in violation of the rule would pay a penalty of $10 per day per bed (that’s over $5,000 a day). Hospitals with 30 beds (or fewer) will pay up as much as $300 per day for violations. This creates an annual penalty range of as little as $110,000 to as much as $2 million for hospitals that continue to fail to make their prices public.

Also included in the proposed changes is a ban intended to eliminate the use of special coding that allows providers to hide their prices from search engine results.

ASC Changes & Backtracking the 2020 Inpatient-Only List

It appears that CMS has proposed eliminating 258 of the 267 procedures they added to the OPP covered procedures list for 2021. We recommend using the link to the full rule provided at the beginning of this blog for further details.

Back in 2020, CMS proposed a three-year-long phase-out of the inpatient-only list. This started with the removal of 298 services. According to the current proposed rule for 2022, however, it appears they are now backtracking on this. In fact, not only are they now planning to scrap the planned phase-out of the list, but they are also adding the 298 services that were previously removed back to the inpatient-only list for 2022.

Corresponding to the return of these procedures to the inpatient-only list, these procedures are being removed from the ASC covered procedure list (CPL). They are proposing that an external party would be able to nominate a procedure to be added back to the list beginning January 1, 2023. ASC providers will need to take care to ensure that they are not performing procedures that are being removed from the list and to determine if they would like to nominate a procedure to be returned to the ASC CPL next year.

Changes to the ASC Quality Reporting Program

The current administration has made it clear that they will be working hard to close the health equity gap and as part of this commitment they are seeking input on how to revise the Hospital Outpatient Quality Reporting program and the ASC Quality Reporting program to better address inequities. Under the ASCQR program they are seeking comment on ways to address the challenges of measuring disparities in the ASC setting, the utility of using Neighborhood-level socioeconomic factors in measuring disparities in quality-of-care outcomes for ASCs, and ways that social risk factors influence access to care, quality of care, and outcomes for ASC patients.

CMS is also proposing to add one new measure to the ASCQR – COVID-19 Vaccination of Health Care Personnel and to make the reporting of 6 voluntary measures mandatory. CMS is providing an opportunity to comment on these proposals as well as all other proposals in the rule.

Want to Comment?

If you are interested in commenting on any of these proposed changes, there is no time like the present. CMS will be accepting comments on the proposed rule until September 17, 2021. You can submit your comments any time before the deadline by going to the designated webpage.

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