CMS' proposed outpatient payment rule for 2021: 5 things to know

CMS has released its Outpatient Prospective Payment System proposed rule for 2021, which would raise Medicare outpatient payment rates next year. 

Here are five takeaways from the 785-page proposed rule

1. Payment update. CMS proposed increasing OPPS rates by 2.6 percent in 2021 compared to 2020. The department estimates that total payments to OPPS providers would be $83.9 billion in 2021, up $7.5 billion from 2020. 

2. 340B program. CMS proposed cutting the payment rate for 340B drugs. Under the proposed rule, CMS would pay hospitals 28.7 percent less than the average sales price for certain drugs purchased through the 340B program. CMS proposed an alternative of continuing its policy of paying hospitals 22.5 percent less than the average sales price for 340B-acquired drugs. 

"We are disappointed but not surprised that the administration has chosen to continue its pursuit of this damaging payment policy," 340B Health, an association of more than 1,400 hospitals, said in a statement. "It should go without saying that during a global pandemic, it is foolhardy for the administration to stubbornly push and worsen a Medicare payment policy that hurts safety-net hospitals and their patients."

3. Inpatient only list. CMS proposed eliminating the inpatient only list over the course of three years beginning with the removal of about 300 services. 

4. Prior authorization. Beginning July 1, 2021, CMS proposed implementing a prior authorization process for the following categories of hospital outpatient department services: cervical fusion with disc removal and implanted spinal neurostimulators. 

5. Comment period. Public comments on the proposed rule are due by Oct. 5. 

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Whitepapers

Featured Webinars