Insights by Engage

The Centers for Medicare and Medicaid Services (CMS), on November 2, 2021, issued the CY2022 Outpatient Prospective Payment System (OPPS) Final Rule (OPPS Final Rule) which, in part, paused the elimination of the Inpatient Only (IPO) list. In the CY2021 OPPS Final Rule, CMS finalized a plan to eliminate the IPO list; a list of services that CMS deemed so complex that Medicare would only pay for when they were performed in an inpatient setting because of the nature of the procedure, the underlying physical condition of the patient, or the need for at least 24 hours of postoperative recovery time or monitoring before the patient can be safely discharged (70 FR 68695). The plan was to fully eliminate the full list over a three (3) year period. The initial elimination for CY2021 had CMS dropping 298 services from the IPO list. There were many comments throughout the rulemaking process as well as post final rule by interested stakeholders concerned that CMS was creating a patient safety concern by eliminating a program which safeguarded many complex services.

CMS Adds Five (5) States Requiring Licensure & Enrollment with NSC  

CMS Proposes New Regulatory Language to Address Contractor Medical Review Requirements 

A Must-Read for Billing Departments

PROVIDERS AND SUPPPLIERS BEWARE…recent audit and program integrity activity has the potential to wreak havoc on your business.  The Centers for Medicare and Medicaid Services (CMS), through their contractors, as well as through changes to their manuals, coupled with activity by the HHS Office of Inspector General (OIG) and Department of Justice (DOJ) indicates that audit activity is on the rise.