Hospital outpatient departments (HOPD) and ambulatory surgery centers (ASC) have about two months to prepare for changes coming in 2022.
The Centers for Medicare and Medicaid Services (CMS) released its CY 2022 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System final rule, Tuesday, November 2. This rule becomes effective Jan/ 1, 2022. You can find the entire rule here.
Below are some highlights from the Avanza team.
PAYMENT RATE CHANGES
CMS is increasing the OPPS payment rate by 2.0% for hospitals that meet quality reporting requirements. In 2019 CMS decided to apply the hospital market basket update to ASC payment rates for CY 2019 through CY2023. For ASC’s that meet quality reporting requirements, they will also receive a 2.0% increase. Note: The ASC Quality Reporting program is currently a pay for reporting program. If ASCs choose not to report, they will experience a 2.0% decrease to their annual payment update for 2022.
INPATIENT-ONLY LIST (IPO LIST)
CMS reversed its 2021 decision to eliminate its IPO list. The agency has added back all procedures that were removed from the list in 2021 except for lumbar spine fusion (CPT 22630), reconstruct shoulder joint (CPT 23472) and reconstruct ankle joint (CPT 27702). Codes for these procedures, along with their associated anesthesia codes, will remain off the IPO list.
ASC-COVERED PROCEDURE LIST (ASC CPL)
CMS has reinstated its 2020 criteria for adding procedures to the list. Additionally, CMS finalized removing 255 of the 258 procedures it proposed to remove from the ASC CPL. The agency chose to keep CPT codes 0499T, 54650 and 60512 on the list.
CMS also finalized a nomination process for external parties to nominate surgical procedures to be added to the ASC CPL. The nomination process begins in March 2022. Nominated procedures reviewed and approved will be added to the ASC CPL for 2023.
SEPARATE PAYMENT FOR NON-OPIOID DRUGS AND BIOLOGICS
For non-opioid drugs and biologics not on pass through status, CMS will continue separate payment for non-opioid drugs or biologics used as procedure supplies. The agency finalized two criteria for these drugs and biologics. First, the drug must be FDA approved for pain management or analgesia. Second, the drug must exceed the 2022 drug packaging threshold of $130/day.
OPPS PAYMENT FOR 340B PROGRAM DRUGS
The agency finalized its proposal to continue with the Average Sale Price (ASP) minus 22.5% payment rate for certain separately paid drugs or biologicals purchased through the 340B Program. In 2018 CMS changed its policy to pay (ASP) plus 6% for drugs purchased through the 340B Program due to the considerable discounts providers receive.
HOSPITAL PRICING TRANSPARENCY
CMS adjusted the pricing transparency rule, most notably to the minimum penalty for noncompliance. Hospitals with 30 or fewer beds will pay $300/day for noncompliance. For hospitals with more than 30 beds, the penalty is $10/bed/day. This penalty is not to exceed $5,500/day.
HAVE QUESTIONS?
The Avanza team continues monitor the impact both legislation and regulation have on HOPDs and ASCs. If you have any questions about these regulations and how they may impact your organization, please contact Joan Dentler, Avanza’s President for a consultation. She can be reached at [email protected].