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CMS MAC/RAC Audit Defense Strategies

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2021 OPPS and ASC Payment System Final Rule: Change Is the Only Constant | Davis Wright Tremaine LLP

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On December 2, 2020, the Centers for Medicare & Medicaid Services (CMS) released the calendar year 2021 Final Rule implementing changes to the Medicare hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System. The Final Rule is issued with comment periods running 30 to 60 days, depending on the provision.
Among the most significant changes in the Final Rule were the:
Phase out of the hospital inpatient only list over a three-year period;
Addition of procedures to the ASC Covered Procedures list;
Removal of restrictions on the expansion for certain physician-owned hospitals; ....

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CMS Releases Calendar Year 2021 Outpatient Prospective Payment System and Ambulatory Surgical Center Final Rule | King & Spalding

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On December 2, 2020, CMS issued the calendar year (CY) 2021 Medicare Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule. Through these policy changes, CMS seeks to provide Medicare beneficiaries and their healthcare providers with more choices to obtain care at a lower cost in an outpatient setting. The provisions of the final rule are effective January 1, 2021.
Through the final rule, CMS is eliminating the Inpatient Only (IPO) list over the course of three calendar years, beginning with the removal of 266 musculoskeletal related services. When removed from the IPO list, these procedures will become eligible for Medicare when provided in a hospital outpatient setting when outpatient care is appropriate. These services will continue to be reimbursed when furnished in the inpatient setting if inpatient care is deemed appropriate by the physician. Procedures ....

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