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

Here are 5 takeaways from the 785-page proposed guideline:.

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

Payment update. CMS proposed increasing OPPS rates by 2.6 percent in 2021 compared to 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 typical prices for specific drugs acquired through the 340B program. CMS proposed an alternative of continuing its policy of paying healthcare facilities 22.5 percent less than the average sales price for 340B-acquired drugs..

” We are disappointed however not surprised that the administration has actually selected to continue its pursuit of this harmful payment policy,” 340B Health, an association of more than 1,400 hospitals, said in a statement. “It needs to go without stating that throughout a global pandemic, it is reckless for the administration to stubbornly push and worsen a Medicare payment policy that harms safety-net medical facilities and their patients.”.

3. Inpatient only list. CMS proposed eliminating the inpatient only list over the course of 3 years starting with the elimination of about 300 services..

4. Prior permission. Starting July 1, 2021, CMS proposed executing a prior permission procedure for the following classifications of hospital outpatient department services: cervical combination with disc elimination and implanted spine neurostimulators..

5. Remark duration. Public remarks on the proposed rule are due by Oct. 5..

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Payment upgrade. CMS proposed increasing OPPS rates by 2.6 percent in 2021 compared to 2020. CMS proposed cutting the payment rate for 340B drugs. Under the proposed rule, CMS would pay health centers 28.7 percent less than the average sales cost for specific drugs bought through the 340B program.

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