Hospitals, payers urge CMS to scrap inpatient payment proposals

Industry groups representing hospitals and health insurers are urging CMS to withdraw certain provisions in its Inpatient Prospective Payment System proposed rule for fiscal year 2021. 

In comments submitted to CMS July 10, the American Hospital Association said it supports several provisions in the proposed rule, but it has "serious concerns" about others. In particular, the AHA said it believes CMS' proposals to collect and apply payer-specific charge data are unlawful. The AHA asked CMS not to finalize those proposals. 

"CMS does not cite authority on which to base the payer-specific data collection requirement or the [Medicare-severity diagnosis-related group] weight recalculation," the AHA said. "In addition, the rule on which CMS relies remains under legal challenge."

Under a final rule issued in November, hospitals are required to disclose the standard charges, including payer-specific negotiated rates, for all services beginning next year. The AHA sued HHS in December in an attempt to block the rule. The group lost the case and filed an appeal in June. 

The AHA is also urging CMS to withdraw its proposal to retroactively apply certain policies related to Medicare bad debt. 

America's Health Insurance Plans also submitted comments on the IPPS proposed rule July 10. The group's comments focus primarily on the proposal to collect rates hospitals negotiate with payers and use them to set market-based MS-DRG weights. 

AHIP argues the proposal would not deliver information that consumers could use to make better healthcare decisions. The group said the proposal would not reduce Medicare beneficiary costs and inadequately assesses the impact on hospitals and health plans. 

"We are concerned that the proposal does not include an adequate assessment of the potential impacts on hospital providers, Medicare Advantage, commercial plans and markets in general," AHIP said. "For example, if the data reported in the publicly available cost report data files is too granular, the proposal could push health care prices higher — not lower — for patients, consumers, and taxpayers."

Read the AHA's full comments here

Read AHIP's full comments here

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