Proposed CMS Physician Fee Schedule and Outpatient Prospective Patient System Rules for 2022

Proposed CMS Physician Fee Schedule and Outpatient Prospective Patient System Rules for 2022

The Centers for Medicare and Medicaid Services (CMS) recently released their proposed rules for the Outpatient Prospective Payment Systems (OPPS) and Physician Fee Schedules for the 2022 calendar year. We’ve collected the key highlights and important changes being proposed to help you understand how you and your organization may be impacted.

The CMS released the 2022 proposed rules for both Outpatient Prospective Payment Systems and Medicare Physician Fee Schedules in mid-July of 2021. Key changes revolve around modifications to the Hospital Price Transparency final rule and the reinstatement of the Inpatient Only List (IPOL). Read more about the individual rules that have been proposed below.

CMS Proposed OPPS Rule for 2022

The 2022 Outpatient Prospective Payment System proposed rule was released by the CMS on July 19, 2021. It includes a variety of proposals, including a 2.3% payment update for hospitals. A majority of the proposals found in the updated rule align with outcomes from COVID-19, initiatives to address health equity gaps, and more transparency across health systems.

A few of the key proposals found in the 2022 proposed rule are:

• Stopping the three-year phase-out of the Inpatient Only (IPO) List that was initiated in 2020 and would have allowed Medicare to pay for procedures in either inpatient or outpatient settings, as determined by the physician. The CMS also proposes adding back in the 298 services removed from the IPO List last year in the initial phase-out.
• Modifications to the Hospital Price Transparency finals rule, including increasing civil monetary penalties and standardization of machine-readable files.
• Usage of CY2019 claims data to set rates for the CY2022 OPPS and Ambulatory Surgical Center Payment System.
• Reinstatement of the ASC Covered Procedures List criteria, including the adoption of a nomination process in which external parties would have the opportunity to nominate surgical procedures to be added to the list.
• Updated payment requirements for non-opioid pain management drugs or biologicals that function as a surgical supply in the ASC setting, making them eligible for separate payments if they are FDA approved (and meet other requirements).
• Updates to Hospital Outpatient Reporting and ASC Quality Reporting Programs to increase meaningful reporting of health disparities based on demographic factors.

Additionally, the CMS seeks comments on the Rural Emergency Hospital (REH) Provider Type Request for Information (which addresses health and safety standards for REHs), as well as on future plans around modernization of digital quality measurements. They are also looking for feedback on the temporary policies put in place as a response to the COVID-19 Public Health Emergency (PHE), including mental health services, practice patterns relying on communication technology, the ability to fulfill direct supervision requirements via audio/video conferencing technology, and hospital outpatient clinic visit specimen collection for COVID-19.

CMS Proposed Physician Fee Schedule Rule for 2022

The CMS also released their proposed 2022 Medicare Physician Feed Schedule on July 13, 2021, which covers Medicare payments and quality provisions for physicians in the 2022 fiscal year. Overall, physicians would see a decrease in conversion factor starting on January 1^st, 2022, moving from $34.89 to $33.58.

Some of the key highlights to the proposed Physician Fee Schedule include:

• Clarifications around telehealth services, physician assistant services, opioid treatment programs, rural health clinics/federally qualified health centers, electronic prescribing of controlled substances, and other topics brought to light as a result of the COVID-19 PHE.
• Multiple proposals that consider recent changes to E/M coding guidelines.
• Delaying the start date of the Appropriate Use Criteria Program penalty phase to January 1^st, 2023, or to the 1^st of the year following the end of COVID-19.
• Removal of two national coverage determinations (NCDs) based on previously developed criteria to address outdated NCDs.

CMS is also seeking feedback on COVID-19 PHE-related topics such as vaccine administration services, telehealth services, and digital quality measurement. An additional proposed policy change related to telehealth includes allowing certain services that were added to the Medicare telehealth list during the COVID-19 PHE to remain on the list through the end of 2023.

Other impacts of COVID-19 can be seen in the proposed updates to the Quality Payment Program Performance Period. The CMS is proposing a several significant changes for 2022, including:

• An implementation timeline for a Merit-based Incentive Payment System Value Pathways and APM Performance Pathways to be included in the 2023 performance period.
• Allowing MIPS eligible clinicians to report the APM Performance Pathway as a subgroup, starting in the 2023 performance year.
• Consideration to retire traditional MIPS, making it no longer available by CY2028 MIPS performance period.
• Establishment of a CY2022 performance threshold score based on the 2017 performance period.
• Updated performance category weights as follows: 30% for the Quality category, 30% for the Cost category, 15% for the Improvement Activities category, and 25% for the Promoting Interoperability category.
• Continuation of the 10-point complex patient bonus for the CY2021 MIPS performance period.
• A revised complex patient bonus to target physicians treating a larger caseload of complex patients for CY2022.
• Updates to quality measure scoring including removing the three-point floor for scoring measures and adding five new episode-based cost measures.
• Updates to Improvement Activities inventory to add health equity-based activities and standardize language related to equity across the full inventory of activities.