CMS Releases Hospital Outpatient Payment Rule

On August 4, CMS released its annual Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) proposed rule. This proposed rule focuses on payment policies for hospital outpatient and ASC services. 

Here are some highlights from the proposed rule.

Eliminating the Inpatient Only List

Currently, CMS maintains the Inpatient Only (IPO) list, which identifies over a thousand services that can only receive payment under Medicare Part A. CMS is proposing to eliminate this list by 2024, starting with 300 musculoskeletal-related services in 2021. The elimination of the list would mean that more services are payable under Medicare Part B.

The elimination of the list also would mean that all those services would become subject to the two-midnight rule (i.e., a physician must believe the patient will stay for a period that passes two midnights or the patient actually stays beyond two midnights). CMS is proposing a two-year exemption from medical review relating to patient status for procedures that are removed from the IPO list from the two-midnight rule.

Physician Supervision

On March 31, 2020, CMS released an Interim Final Rule that reduced the minimum level of supervision for non-surgical extended duration therapeutic services to general supervision for the duration of the COVID-19 pandemic. CMS also has allowed direct supervision via video/audio technology for pulmonary rehabilitation services, cardiac rehabilitation services, and intensive cardiac rehabilitation services throughout the COVID-19 pandemic. CMS is proposing to adopt these policies permanently.

Read fact sheet.

Comments to the proposed rule are due by October 5, 2020. ACOFP is still reviewing the proposed rule and plans on submitting comments.