The proposed 2021 Hospital Outpatient Prospective Payment System (OPPS) rule was released by the Centers for Medicare and Medicaid Services (CMS) on Aug. 3 in tandem with the proposed 2021 Medicare Physician Fee Schedule. The outpatient rule indicates a 2.6 percent payment update for hospitals and other proposals. Highlights from the OPPS rule include:

• Proposed establishment of an Overall Hospital Quality Star Rating system for 2021, aimed at simplifying methodology and increasing comparability between facilities.
• Proposed elimination of the Inpatient Only (IPO) procedure list over the course of three calendar years, beginning with the removal of approximately 300 musculoskeletal-related services.
• A proposal to allow direct supervision for pulmonary rehabilitation, cardiac rehabilitation, and intensive cardiac rehabilitation services to include virtual presence of the physician through audio/video real-time communications technology subject to the clinical judgment of the supervising physician. This would begin in 2021.
• A proposal to remove exclusion criteria that prevent many services from being placed on the Ambulatory Surgery Center Covered Procedures list for 2021 in light of the COVID-19 public health emergency and a desire to promote competition.

Download a comprehensive PDF with highlights from both proposed rules. CMS’s fact sheet is located here.

Keywords: ACC Advocacy, Relative Value Scales, Centers for Medicare and Medicaid Services, U.S., Medicare, Healthcare Common Procedure Coding System

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