Medicare payment rules for 2021: 11 notes for hospital execs

CMS in the past week has proposed Medicare payment rules for outpatient services and physicians for 2021 and finalized payment rules for inpatient rehabilitation hospitals and psychiatric facilities. 

Below are 11 takeaways from the final and proposed rules. 

Outpatient Prospective Payment System proposed rule 

1. CMS proposed increasing OPPS rates by 2.6 percent in 2021 compared to 2020. 

2. 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.

3. The proposal would eliminate the inpatient only list over the course of three years. 

Read the 785-page proposed rule here

Physician Fee Schedule proposed rule 

4. With the budget neutrality adjustment to account for changes in relative value units, as required by law, the proposed Physician Fee Schedule conversion factor for 2021 is $32.26, down from $36.09 in 2020. 

5. CMS proposed adding several services to the Medicare telehealth services list during the public health emergency for the COVID-19 pandemic, including home visits for established patients and psychological and neuropsychological testing.

6. The department proposed adding the following services to the list of Medicare telehealth services on a Category 1 basis because the services are similar to those already on the list: 

  • Visit complexity associated with certain office/outpatient evaluation and management 
  • Prolonged services 
  • Group psychotherapy 
  • Neurobehavioral status exam
  • Care planning for patients with cognitive impairment
  • Domiciliary, rest home or custodial care services
  • Home visits 

7. CMS proposed a refinement to clarify the times when prolonged office and outpatient evaluation and management visits can be reported. 

8. Under the proposal, the implementation of Merit-based Incentive Payment System Value Pathways would be delayed until at least 2022 due to the COVID-19 pandemic. 

Read the 1,353-page proposed rule here

Inpatient Rehabilitation Facility Prospective Payment System final rule

9. The Medicare payment rate for inpatient rehabilitation facilities will increase by 2.4 percent in 2021 compared to this year. 

10. CMS eliminated the requirement for physicians to conduct a post-admission visit during the COVID-19 public health emergency. The final rule permanently eliminates the requirement. 

Read the 126-page final rule here

Inpatient Psychiatric Facilities Prospective Payment System final rule 

11. The Medicare payment rate for inpatient psychiatric facilities will increase by 2.2 percent in fiscal year 2021 compared to this year. 

Read the 78-page final rule here.

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