CMS Releases 2022 OPPS Proposed Rule – Elimination of IPO List Halted?
CMS released the Proposed Rule for Outpatient Prospective Payment System (OPPS) on July 20, 2021. The changes will take effect on January 1, 2022 (Federal Register, 2021). CMS is accepting comments on the rule through September 17, 2021, with release of the Final Rule expected by approximately November 1, 2021. Though not yet finalized, the changes proposed include some reversals of previous policies along with other adjustments. Perhaps the most surprising proposal is a reversal of the decision to abolish the Inpatient Only (IPO) list.
The 2022 Hospital OPPS and APC Changes course is now live on the YES HIM Education site. The course reviews the OPPS APC-specific policy changes, the plans to eliminate the Inpatient Only (IPO) list, and other topics in the Final Rule.
Changes in the OPPS Proposed Rules
The IPO list includes procedures that Medicare will pay for only when care takes place in a hospital inpatient setting. Last year’s Final Rule established a plan to eliminate the list completely over a three-year phase-in period. In addition, CMS removed 298 services from the IPO list for 2021. The 2022 Proposed Rule suggests not only that the IPO list should remain. The Proposed Rule also suggests CMS should add back the 298 services they removed from the IPO list in 2021.
The Proposed Rule proposes an increase in OPPS payment rates of approximately 2.3%. Claims data from CY 2019, rather than CY 2020, would be used for rate-setting to compensate for anomalies during the COVID-19 Public Health Emergency (PHE). This would also affect the equitable adjustment for devices, drugs and biologicals with expiring pass-through status. Separate payments for 27 drugs and biologicals and one device category that were set to expire between December 31, 2021, and September 30, 2022, would continue to be provided. Eight additional applications are being considered for 2022.
The Proposed Rule also suggests a number of modifications to the hospital Price Transparency Rule. This includes significant escalation of civil monetary penalties for noncompliance with the rule. This rule took effect on January 1, 2021. It requires hospitals to publicly post their standard charges for items and services via the internet in a machine-readable format.
As always, the Proposed Rule includes possible variations within Ambulatory Payment Classification (APC) groups and recalibration of payment rates, proposals for New Technology APCs, and other changes. Stay tuned for a comprehensive review of the Final Rule in the YES 2022 OPPS Updates presentation later this year.
For additional information regarding ICD-10 and the other payment system annual updates, review these articles:
- What You Need to Know About the 2022 Home Health Prospective Payment System Proposed Rule
- 2022 IPPS Proposed Rule Includes New Codes, Proposed MS-DRG Changes & Bi-Annual Code Update Possibility
- 2022 ICD 10 CM Updates Now Available – Post COVID-19 and SDH Codes Included
Ann Zeisset, RHIT, CCS, CCS-P, co-authored this article with Teri Jorwic, MPH, RHIA, CCS, CCS-P, FAHIMA.