News: 2022 OPPS proposed rule released, CMS backs off eliminating inpatient-only list, and increasing price transparency penalties

CDI Strategies - Volume 15, Issue 30

Less than a year after CMS finalized the three-year phaseout of the inpatient-only (IPO) list to be completed by 2024, the agency is looking to reverse course, according to the 2022 OPPS proposed rule, released Monday, July 19.

In addition, CMS says it intends to increase hospital compliance with its price transparency policies by increasing financial penalties for certain facilities, among other proposals related to 2-midnight policy medical reviews and potentially codifying certain policies created during the COVID-19 public health emergency (PHE), Revenue Cycle Advisor reported.

IPO list reversal

Citing “a large number of stakeholder comments” received during and after the 2021 rulemaking cycle that opposed the gradual elimination of the IPO list due patient safety concerns, CMS proposes to halt the previously finalized three-year phase and restore the 298 services removed from the IPO list on January 1.

The agency proposes  codifying its own criteria for removing procedures from the IPO list in the 2022 OPPS proposed rule, Revenue Cycle Advisor reported. CMS is also seeking comment on whether the agency should continue to maintain the IPO list or return to a “longer-term objective” of eliminating it.

Increasing penalties for price transparency noncompliance

Following a recent JAMA Internal Medicine study that found 75% of the country’s 100 highest-revenue hospitals were noncompliant with at least one of the major requirements of CMS’ price transparency policy effective January 1, the agency is proposing reforms to increase compliance.

CMS appears intent on raising civil monetary penalties (CMP) on large providers that do not comply, but is seeking comment on what criteria to use to scale the CMPs appropriately, Revenue Cycle Advisor reported. The criteria includes:

  • Hospital revenue
  • The nature, scope, severity, and duration of noncompliance
  • The hospital’s reason for noncompliance

This scaled approach is intended to maintain the current penalty for small hospitals but increase it for larger hospitals. For example, CMS proposes a minimum CMP of $300 per day for hospitals with 30 or fewer beds and adding $10 per bed per day for hospitals with more than 30 beds. This penalty would be capped at $5,500 per day.

If CMS moves forward with this proposal, the minimum total annual penalty for a year of noncompliance would be $109,500 and the maximum would be $2,007,500.

The agency is considering administrative changes in addition to tweaking the CMPs. CMS proposes the machine-readable file of standard charges should be accessible to automated searches and direct downloads. For facilities using online price estimator tools, CMS is clarifying that the tool must provide a cost estimate that takes the consumer’s individual insurance information into account. The hospital tool must provide an estimate that reflects the amount the facility expects the patient will pay, barring unusual or unforeseen circumstances.

CMS is seeking comment on the following topics related to price transparency:

  • Considerations for best practice online price estimator tools
  • Improving expectations related to plain language descriptions of shoppable services
  • Methods to identify and highlight exemplar hospitals
  • Improving standardization of the machine-readable files

Extending PHE policies

While CMS is not outright extending provider flexibilities granted as part of the COVID-19 PHE, the agency is seeking feedback on several regulations it could make permanent.

Specifically, CMS is asking stakeholders to comment on:

  • How much providers relied on flexibility within the direct supervision requirement for pulmonary, cardiac, and intensive cardiac rehab. The PHE allowed for a provider’s virtual presence through audio/video real-time communications to reduce risks for both the provider and the beneficiary.
  • The extent to which hospitals have been billing for mental health services furnished to beneficiaries in their homes through communication technology during the PHE, and whether continued demand for such care is anticipated.
  • Whether CMS should keep HCPCS code C9803 (hospital outpatient clinic visit specimen collection for COVID-19, any specimen source) active beyond the conclusion of the COVID-19 PHE and whether it should extend or make permanent the OPPS payment associated with specimen collection for COVID-19 tests after the COVID-19 PHE ends.
  • Whether there are any changes that CMS should make to account for shifting practice patterns that rely on communication technology to provide mental health services to beneficiaries in their homes.

Additional information

To read more about policies in the 2022 OPPS proposed rule, see CMS’ fact sheet and press release.

To learn more about the proposed rule’s policies and what payment impact they could have at your facility, attend HCPro’s annual OPPS proposed rule webinar with Shah and Valerie A. Rinkle, MPA, CHRI.

Editor’s note: This article was originally published by Revenue Cycle Advisor.

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