Becker’s Hospital Review recently wrote this article about key items in the CMS Outpatient Rule for 2021. The items listed below present an overview of the more important points in the rule. A link to the final rule is included for your reference.
CMS released its Outpatient Prospective Payment System final rule for 2021, which raises Medicare outpatient rates by 2.4 percent next year and phases out the inpatient only list.
Here are a few key items from the 1,312-page final rule:
1. Inpatient only list. CMS is eliminating the inpatient only list over the course of three years. About 300 mostly musculoskeletal-related services will be removed first, followed by the rest of the inpatient only list by 2024. Procedures cut from the inpatient only list will be exempt from site-of-service claims denials under Medicare Part A. “This exemption will last until we have Medicare claims data indicating that the procedure is more commonly performed in the outpatient setting than the inpatient setting,” CMS said.
2. 340B program. CMS is continuing the current policy of paying hospitals 22.5 percent less than the average sales price for 340B-acquired drugs. “We believe maintaining the current payment policy is appropriate in order to maintain consistent and reliable payment amid the [public health emergency],” CMS said.
3. Prior authorization. Beginning July 1, 2021, CMS is implementing a prior authorization process for the following categories of hospital outpatient department services: cervical fusion with disc removal and implanted spinal neurostimulators.
4. Hospital reporting. CMS is finalizing a new requirement that the nation’s 6,200 hospitals report information about their inventory of therapeutics to treat COVID-19.
5. Star ratings. The rule finalizes revisions to the hospital star ratings methodology, including calculating measure group scores using a simple average. CMS did not finalize a proposal to stratify hospitals by proportion of dual-eligible patients.
We agree with some of the Industry professional groups regarding the need to standardize the protocols for prior authorization and question the reduction of 22.5% for participants of the 340B program. These two changes during a PHE for COVI-19 is particularly burdensome for hospitals and physicians.