On August 4, 2020, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2021 proposed rule titled “Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; New Categories for Hospital Outpatient Department Prior Authorization Process; Clinical Laboratory Fee Schedule: Laboratory Date of Service Policy; Overall Hospital Quality Star Rating Methodology; and Physician-owned Hospitals.“
Highlights of the proposed rule include:
- CMS is proposing to eliminate the Inpatient Only (IPO) list over a three-year transitional period with the list completely phased out by CY 2024
- CMS is proposing to expand the number of procedures that Medicare would pay for when performed in an Ambulatory Surgical Center (ASC), including a total hip arthroplasty
- CMS is proposing to establish, update, and simplify the methodology that would be used to calculate the Overall Hospital Quality Star Rating
- CMS is proposing to include critical access hospitals (CAHs) in the Overall Star Rating as well as Veterans Health Administration (VHA) hospitals
- CMS proposes to update OPPS payment rates for hospitals that meet applicable quality reporting requirements by 2.6 percent
- CMS is proposing to update the ASC rates for CY 2021 by 2.6 percent
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