Prospective Payment

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April 2021
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New year brings some changes to quality reporting criteria

The 2021 Medicare Hospital Outpatient Prospective Payment System (OPPS)/ASC Final Payment Rule was released on December 1, 2020, and became effective as of January 1, 2021. Gina Throneberry, MBA, RN, CASC, CNOR, director of education and clinical affairs, Ambulatory Surgery Center Association (ASCA), summarized the status of Medicare regulations and…

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By: Elizabeth Wood
January 19, 2021
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CMS threatens to withhold payments from hospitals not reporting COVID-19, flu data

Editor's Note The Centers for Medicare and Medicaid Services (CMS) on October 6 released guidance on how it will implement an interim final rule that requires hospitals and critical access hospitals to report data on COVID-19 and flu patients. CMS says failure to report specified data may lead to termination…

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By: Judy Mathias
October 8, 2020
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CMS issues final inpatient payment rule for FY 2021

Editor's Note The Centers for Medicare & Medicaid Services (CMS) on September 2 issued its final inpatient prospective payment system (IPPS) rule, which will: increase IPPS rates by 2.9% in FY 2021 for hospitals that report quality data and are meaningful users of electronic health records, resulting in an increase…

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By: Judy Mathias
September 8, 2020
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CMS to increase pay to hospitals for care of COVID-19 patients

Editor's Note The Centers for Medicare & Medicaid Services (CMS) on August 17 updated its patient payment guidance to increase hospital reimbursement for care of COVID-19 patients by 20%. The payment increase will take effect September 1. Among requirements for hospitals to receive the Medicare payment increase: Patients must have…

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By: Judy Mathias
August 24, 2020
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ASC offsets some revenue loss through 'Hospital Without Walls' waiver

Far fewer cases of COVID-19 have been seen in rural areas of the US than in large urban populations. But even healthcare facilities not inundated with COVID-19 patients have sustained revenue losses and disruptions in standard procedures. One major advantage for Heartland Surgery Center in Kearney, Nebraska, was seeing the…

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By: Elizabeth Wood
June 17, 2020
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Proactive payment collection reduces bad debt risk

Establishing policies to collect payment before surgery has grown in importance as high-deductible health plans impose larger out-of-pocket costs on patients. To help manage patients’ expectations about costs and increase the likelihood of collecting payment, some experts believe a culture shift is in order. They say healthcare facilities should be…

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By: Jennifer Lubell
June 17, 2020
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CMS releases proposed inpatient payment rule for FY 2021

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…

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By: Judy Mathias
May 13, 2020
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CMS proposes giving Medicare patients better access to cutting-edge devices

Editor's Note In its proposed rule, the Centers for Medicare & Medicaid Services (CMS) would give Medicare patients better access to innovative devices beginning next year, the July 30 MassDevice reports. CMS also says it might pay more for “certain transformative new devices” for inpatients, using a new technology add-on…

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By: Judy Mathias
August 1, 2019
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CMS maintains site-neutral cuts in 2020 proposed rule

Editor's Note The Centers for Medicare & Medicaid Services (CMS) on July 29 issued the 2020 proposed payment rule for ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs), which would increase Medicare hospital outpatient prospective payment system rates by 2.7%. CMS is also proposing to add eight codes to…

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By: Judy Mathias
July 31, 2019
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ASCs react to 2019 regulatory changes

Each year, ambulatory surgery centers (ASCs) adapt to numerous federal regulatory policy reforms. As an example, since 2012, when the Centers for Medicare & Medicaid Services (CMS) launched the Ambulatory Surgery Center Quality Reporting (ASCQR) Program ASCs had been asking for, ASCs have reported data for a changing set of…

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By: Judith M. Mathias, MA, RN
February 20, 2019
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