The Medicare Outpatient Prospective Payment System final rule for calendar year 2022 continues cuts to hospitals in the 340B Drug Pricing Program and pauses elimination of the inpatient-only list. The rule also includes provisions on price transparency, rural emergency hospitals, and health equity.

Proposed rules for Medicare’s Outpatient Prospective Payment System and Physician Fee Schedule would continue Medicare Part B cuts, continue site-neutral policies, and halt the phase-out of the inpatient-only list. Both rules also contain an information request on closing the health equity gap.

America's Essential Hospitals commented on several policy proposals of interest to essential hospitals in the Inpatient Prospective Payment System rule and responded to a request for information on closing the health equity gap in hospital quality programs.

Health care providers have until Dec. 3 to download their preview reports, which include overall hospital quality star ratings.

This year’s release includes some changes in both the information released and its classification.

Agencies seek information on quality reporting to help reduce the burden on eligible hospitals and providers; comments are due Feb. 1.

RACs will not conduct postpayment reviews of patient status for Medicare claims with an inpatient admission between Oct. 1 and Dec. 31, 2015.

Agency proposes to reduce slightly payment rates for hospital outpatient services, relax some provisions of the two-midnight policy, and update quality reporting measures.

Annual release includes 2013 data related to the 100 most common diagnoses for Medicare patients requiring inpatient stays and 30 selected outpatient procedures.

The legislation would extend the partial enforcement delay of the two-midnight policy and require CMS to develop new criteria for inpatient stays that last fewer than two midnights. Association President and CEO Bruce Siegel, MD, MPH, said, "It's vitally important that we get this policy right so that we don't inadvertently destabilize hospitals that care for the vulnerable."

CMS stated that MACs must re-review all claims denials under the probe and educate process. CMS also released a new document that provides initial data collected from the inpatient hospital probe and educate reviews.

The OIG and HHS FY 2014 work plan includes several Medicare and Medicaid projects. These projects cover the following topics including inpatient admission criteria, E&M payments, IME, and provider taxes.

CMS will discuss inpatient hospital admission and medical review criteria and answer questions. A partial delay of the policy was instituted Nov. 5, 2013, and extended Jan. 31. Now recovery audit contractors and Medicare administrative contractors will not conduct postpayment patient status reviews for inpatient admissions with dates of service between Oct. 1, 2013 and Sept. 30, 2014.

CMS posted further guidance extending the partial delay of the two-midnight policy for inpatient admission and medical review through Sept. 30. For inpatient admissions with dates of service between Oct. 1, 2013 and Sept. 30, 2014, recovery audit contractors and Medicare administrative contractors will not conduct postpayment patient status reviews.

Inpatient population and sampling data for chart-abstracted quality measures for the third quarter of 2013 (discharges from July 1 through Sept. 30, 2013) will be due Feb. 8 for the IQR Program. Outpatient population and sampling data and outpatient chart-abstracted measures will be due Feb. 8 for the OQR Program.

Call will cover inpatient hospital admission, medical review criteria and offer case scenarios

Revised policy presumes inpatient admissions fewer than two midnights are inappropriate for inpatient reimbursement

The VBP program links Medicare inpatient payments to quality measure performance

Offered direction on how to select hospital claims during inpatient probe and educate program

Rule establishes presumption of medical need for Medicare hospital inpatient admissions that span two midnights

Cited concerns that hospitals may be undercompensated for providing necessary services that do not meet new criteria

Will take comment on physician order and certification, medical review criteria, and other issues

Hospital inpatient quality reporting program intended to provide consumers with quality of care information

Responds to CMS concern that Medicare and beneficiaries might pay more for outpatient care

Education targeted at staff involved in reporting summary data to the National Healthcare Safety Network

Association urges CMS to accurately capture uncompensated care data to implement Medicare DSH cuts