![]() The payment adjustments will be the additional payments needed to result in a payment-to-cost ratio (PCR) equal to 0.89 for each cancer hospital. Cancer Hospital Payment AdjustmentĬMS will continue to provide additional payments to cancer hospitals. CMS will continue its policy that if a Community Mental Health Center's (CMHC) cost for partial hospitalization services, paid under APC 5853 (Partial Hospitalization for CMHCs), exceeds 3.40 times the payment rate for proposed APC 5853, then the outlier payment would be calculated as 50 percent of the amount by which the cost exceeds 3.40 times the proposed APC 5853 payment rate. With the outlier payment calculated as 50 percent of the amount, the cost of furnishing the service exceeds 1.75 times the APC payment amount. CMS sets thresholds for outlier payments to when a hospital's cost of furnishing a service both exceeds 1.75 times the ambulatory payment classification (APC) payment amount and exceeds the APC payment amount plus $6,175. CMS will continue estimating outlier payments to be 1.0 percent of the estimated aggregate total payments under the OPPS for CY 2022, with an amount equal to less than 0.01 percent of outlier payments to be allocated specifically for community mental health centers for partial hospitalization program (PHP) outlier payments. ![]() OPPS provides outlier payments to hospitals to help mitigate the financial risk associated with high-cost and complex procedures. ASC Payment Rates and UpdatesĬMS will update the ASC rates for CY 2022 by 2.0 percent for ASCs meeting relevant quality-reporting requirements. HOPDs failing to meet quality reporting requirements will continue to receive a 2.0 percent reduction in payments for OPPS services. ![]() This would be an increase of approximately $10.757 billion from CY 2021. CMS anticipates that the CY 2022 update, along with changes in enrollment, utilization and case mix, will result in total payments of approximately $82.704 billion to hospital outpatient department (HOPD) providers. ![]() This update is based on the projected hospital market basket increase of 2.7 percent, reduced by 0.7 percent for the productivity adjustment. OPPS Payment Rates and UpdatesĬMS will update OPPS payment rates for hospitals that meet applicable quality reporting requirements by 2.0 percent. īelow is a summary of highlights of the Final Rule. Updates were made to the Radiation Oncology Model, which will not be further delayed and will begin on Jan.CMS will halt the elimination of the Inpatient Only (IPO) list and remove the regulatory references to the elimination of the list – a huge win for hospitals that would have seen lower payments as a result of this policy.CMS will continue the payment rate of Average Sale Price (ASP) minus 22.5 percent for separately payable drugs or biologicals acquired through Section 340B of the Public Health Service Act (340B Program).Despite pushback, CMS will dramatically increase financial penalties to as much as $5,500 per day, or over $2 million per year, for noncompliance under the hospital price transparency rules.To learn more about the OPPS and ASC Final Rule, review the following resources: 2, 2021, finalizing payment rates and policy changes affecting Medicare services furnished in hospital outpatient and ambulatory surgical center (ASC) settings for CY 2022. The Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule on Nov.
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