Reimbursement

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January 2021
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COVID-19 has hastened outpatient surgery migration

The latest surge of COVID-19 cases has put many hospitals in a precarious position, with shortages of staff, space, and supplies. Lessons learned earlier in the pandemic cannot necessarily shore up systems that have been overwhelmed with patients. Throughout most of 2020, some patients postponed medical or surgical care. When…

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By: Elizabeth Wood
December 15, 2020
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CMS releases final 2021 Medicare payment rule for ASCs, HOPDs

Editor's Note The Centers for Medicare & Medicaid Services (CMS) on December 2 released its 2021 final payment rule for ASCs and hospital outpatient departments (HOPDs). CMS has finalized the addition of 11 procedures to the ASC covered procedures list, including total hip arthroplasty, autochondrocyte knee implant, and open complex…

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By: Judy Mathias
December 3, 2020
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CMS releases final PFS for 2021, surgeons say rule jeopardizes care

Editor's Note The Centers for Medicare and Medicaid Services (CMS) on December 1 released its 2021 final rule for the Medicare physician fee schedule (PFS), which expands telehealth services and increases payments for primary care and chronic disease management. The rule also reduces payments for surgeons, emergency physicians, and other…

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By: Judy Mathias
December 2, 2020
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Shifts in case mix bode well for future of outpatient surgery

Before COVID-19 emerged as the biggest disruptor of 2020, many ambulatory surgery centers (ASCs) had been growing volume and receiving Medicare reimbursements for an increasing number of procedures. Stopping elective procedures in the spring was a significant setback, especially for smaller, independent facilities, notes a Global Healthcare Advisors (GHA) brief,…

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By: Elizabeth Wood
November 17, 2020
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CMS: How to prepare for COVID-19 vaccine

Editor's Note The Centers for Medicare and Medicaid Services (CMS) on November 5 released a set of toolkits and enrollment actions to take to administer the COVID-19 vaccine when it’s available. Many Medicare-enrolled providers don’t have to take any actions until the vaccine is available. Some Medicare-enrolled providers must also…

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By: Judy Mathias
November 5, 2020
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CMS penalizes 2,545 hospitals for high readmissions

Editor's Note The Centers for Medicare and Medicaid Services (CMS) will penalize and reduce a year’s worth of payments to nearly half of the nation’s hospitals because of 30-day readmission rates, the November 2 Kaiser Health News reports. The penalties are part of the ninth year of the Hospital Readmissions…

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By: Judy Mathias
November 3, 2020
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Think 'outside the blocks' to shore up balance sheets

Editor’s Note: This article from Whitman Partners addresses some ways OR nurse leaders can help their health systems recover from the financial fallout and disruption in normal processes caused by the COVID-19 pandemic. Whitman Partners is a Portland, Oregon-based specialty search firm dedicated to placing directors of surgical services at…

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By: Carisa Brewster
October 21, 2020
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Consider a PSH as a post-pandemic strategy

Across the US, surgical services are estimated to comprise around 20% of national health spending and typically generate up to 70% of total health system revenue.1, 2 That makes surgical services the largest revenue generator for a hospital, supporting access to numerous other healthcare services. Considering the average hospital has…

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By: Barbara McClenathan, MBA-HCM, BSN, RN, CNOR and Lisa Branding, MHSA
October 21, 2020
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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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