CMS also released the 2021 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System (OPPS) Final Rule. CMS added THA to the list of ASC Medicare covered procedures. CMS is proceeding with its plans to eliminate the inpatient only (IPO) list over 3 years, beginning with the removal of most orthopaedic surgical codes in 2021.
CMS is finalizing a policy to exempt procedures that are removed from the IPO list beginning in 2021 from site-of-service claim denials, Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO) referrals to Recovery Audit Contractors (RACs) for persistent noncompliance with the 2-midnight rule, and RAC reviews for “patient status” (that is, site-of-service) until such procedures are more commonly billed in the outpatient setting. In response to AAHKS comments, CMS extended its proposed 2-year exemption period to this indefinite exemption period.
For more information, read our summary (starting on page 3).