May 13, 2020

CMS releases proposed inpatient payment rule for FY 2021

By: Judy Mathias
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Editor's Note

The Centers for Medicare & Medicaid Services (CMS) on May 11 released a proposed rule that increases Medicare inpatient prospective payment system (IPPS) rates by a net of 3.1% in FY 2021, compared to 2020, for acute care hospitals participating in the Hospital Inpatient Quality Reporting Program that demonstrate meaningful use of electronic health records (EHRs). Overall IPPS payments would increase by about 1.6%.

CMS also proposes:


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  • a new Medicare-Severity Diagnosis-Related Group for chimeric antigen receptor (CAR) T-cell therapy as well as 490 novel, 47 revised, and 58 withdrawn ICD-10-CM codes
  • distributing $7.8 billion in disproportionate share hospital payments in FY 2021, a decrease of more than $500 million, compared with FY 2020
  • adding new technology payments for certain antimicrobials approved under the Food and Drug Administration’s Limited Population Pathway for Antibacterial and Antifungal Drugs
  • changing the Inpatient Quality Reporting Program, starting with the 2021 reporting period, by gradually increasing the number of quarters of electronic clinical quality measure data until it reaches a full year of data for the 2023 reporting period.

CMS will accept comments on the proposed rule through July 10.

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