Final CMS 2022 Outpatient Rule Reinstates Inpatient Only List, Increases Transparency Penalties

November 3, 2021

On November 2, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that increases Medicare hospital outpatient prospective payment system rates by a net 2.0% in calendar year 2022 compared to 2021. WSHA is preparing a comprehensive summary and hospital-specific analyses of the final rule which will be sent to each hospital’s CFO or designated finance person when completed within the next few weeks.

In the final rule, CMS finalized its proposal to halt the elimination of the inpatient only (IPO) list and reinstated services removed under the 2021 rule. It also finalized its proposal to reinstates patient safety criteria for adding a procedure to the ambulatory surgical center covered procedures list (CPL) and removed 255 of the 258 surgical procedures that had been added to the ASC CPL in 2021. WSHA supported both of these proposals in its comments on the proposed rule.

CMS will increase the civil monetary penalty (CMP) for hospitals that are determined to be noncompliance with the federal transparency law requiring hospitals to disclose their negotiated rates with insurers in a machine-readable format. CMS finalized its proposal to scale up the CMP based on bed count, up to a maximum of $5,500 per day for large hospitals. The CMP will remain at $300 per day for hospitals with 30 or fewer beds. (Andrew Busz, )


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