CMS Pushes for Site Neutrality

Monday, December 14, 2020

On December 2, 2020, the Facilities for Medicare & Medicaid Providers (“CMS”) finalized insurance policies that “intention to extend selection, decrease sufferers’ out-of-pocket prices, empower sufferers, and defend taxpayer {dollars}” with adjustments to the Medicare Hospital Outpatient Potential Fee System (“OPPS”) and the Ambulatory Surgical Middle (“ASC”) Fee System within the Medicare OPPS and ASC Remaining Rule (“Remaining Rule”). These adjustments embrace: elimination of the “Inpatient Solely Listing” and additions and revisions to the “ASC Coated Procedures Listing” – two key areas of “web site neutrality”. Web site neutrality is a transfer to decrease or remove the reimbursement variations between totally different websites of service.

The Remaining Rule can be revealed December 29, 2020.

Eliminating the Inpatient Solely Listing

The Remaining Rule contains finalizing CMS’ proposal to remove the Inpatient Solely checklist over a three-year transitional interval. The Inpatient Solely checklist is an inventory of providers designated by Medicare as solely acceptable to be furnished in a hospital inpatient setting. Typically, however not all the time, “inpatient solely” providers are surgical providers that require inpatient care due to the:

Nature of the process,

Typical underlying bodily situation of sufferers who require the service, or

Want for at the least 24 hours of postoperative restoration time or monitoring earlier than the affected person will be safely discharged.

The change will make all providers on the Inpatient Listing obtainable to be offered within the outpatient setting, when outpatient care is suitable, as decided by the doctor. CMS will begin the phase-out starting with the elimination of roughly 300 primarily musculoskeletal-related providers, with the checklist fully phased out by 2024.

Moreover, the Remaining Rule establishes that procedures faraway from the Inpatient Solely checklist starting January 1, 2021, can be indefinitely exempted from site-of-service declare denials beneath Medicare Half A, sure referrals for noncompliance with the “2-midnight rule” (inpatient admission and fee are acceptable when the treating doctor expects the affected person to require a keep that crosses two midnights and admits the affected person primarily based on that expectation), and critiques for site-of-service (“affected person standing”). CMS intends this exemption to final till there’s knowledge indicating that the exempted process is being extra generally carried out within the outpatient setting than the inpatient setting, to permit suppliers extra time to change into accustomed to the brand new skill to invoice Medicare for providers that had been beforehand solely paid on an inpatient foundation.

Additions and Revisions to the ASC Coated Procedures Listing

The Remaining Rule additionally makes adjustments to the ASC Coated Procedures checklist to supply sufferers extra selections for providers at ASCs. Below CMS’ normal overview course of, the Remaining Rule provides 11 procedures to the checklist for 2021. As well as, the Remaining Rule revises the standards for including lined surgical procedures to the ASC Coated Procedures checklist, and supplies that sure standards CMS used so as to add lined surgical procedures to the checklist will now be components for physicians to think about in deciding whether or not a selected beneficiary ought to obtain a lined surgical process in an ASC, and adopts a notification course of for surgical procedures the general public believes will be added to the ASC Coated Procedures checklist beneath the standards CMS is retaining. Utilizing this revised standards, the Remaining Rule additionally provides an extra 267 surgical procedures to the ASC Coated Procedures checklist starting in 2021.