This month the Centers for Medicare & Medicaid Services (CMS) released both the CY 2022 Medicare Physician Fee Schedule (PFS) proposed rule and the CY 2022 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System (OPPS & ASC) proposed rule. Proposals in the PFS include:

  • CMS proposes to allow expiration of the one-time 3.75% payment increase Congress provided through the Consolidated Appropriations Act, 2021, which would mean a PFS conversion factor of $33.58—a $1.31 decrease from the 2021 conversion factor of $34.89—to reflect the proposed budget neutrality adjustment that accounts for changes in relative value units (RVUs).
  • 2023 Implementation of MIPS Value Pathways (MVPs) including one for lower extremity joint repair. AAHKS has met with CMS to discuss development of this MVP.
  • Proposed changes to the Stark laws
  • Proposed Changes to the Requirements for Electronic Prescribing for Controlled Substances for a Covered Part D Drug under a Prescription Drug Plan or an MA-PD Plan

And in the OPPS:

  • CMS proposes to reverse the elimination of the IPO list and reinstate the earlier criteria for individual procedure removal determinations. All of the orthopedic procedures removed in 2021 would be reinstated to the IPO list in 2022. This does not apply to TKA and THA (earlier removed on an individual basis) which would remain available for outpatient reimbursement.
  • CMS proposes reversal of the elimination of the ASC covered procedures list (CPL) criteria and return most of the 267 procedures removed this year to the list.  A new process would be in place to nominate procedures for the ASC CPL beginning in 2023.  This does not apply to TKA and THA which were added to the ASC CPL on an individualized basis.
  • CMS proposes to return to the 2-year exemption from site-of-service claim denials, BFCC-QIO referrals to RACs, and RAC reviews for site-of-service questions for procedures that are removed from the IPO list. This is in contrast to last year’s “indefinite exemption” from such reviews.
  • Beginning in 2020 CMS requires that hospitals disclose their standard charges online or face penalties. The penalties have been reported to be so low that many hospitals are simply choosing to pay them rather than disclose charges. CMS proposes to significantly increase the penalties to drive compliance.
  • CMS is seeking comment on potentially adding a patient-reported outcomes measure for THA and TKA for both OPPS procedures and ASC procedures.

Read the combined proposed rule summaries on our site for more detail. The summary includes a chart summarizing proposed changes for Medicare rates in 2022 at a national level; please note that regional rates may differ. AAHKS will comment on both proposed rules before their September 13 deadline and will assist members in submitting individual comments to their Congressional representatives.

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