CMS Maintains Hospital Transparency Price Rule, Other Federal Rules, AMA Releases New CPT Codes, and AAAHC Issues New Standards Banner Image

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CMS Maintains Hospital Transparency Price Rule, Other Federal Rules, AMA Releases New CPT Codes, and AAAHC Issues New Standards

September 16, 2020

For more information about this blog post, please contact Khaled J. KleleRyan M. MageeLabinot Alexander Berlajolli, or Daniel J. Parziale.

Objections, CMS Maintains Hospital Transparency Pricing Rule in the Inpatient
Prospective Payment System Final Rule for 2021

Centers for Medicare &
Medicaid Services (“CMS”)
has released its Inpatient Prospective Payment System (“IPPS”) final rule for fiscal
year (“FY”) 2021, effective October 1, 2020. The rule affects
approximately 3,200 acute care hospitals. Over the objections of numerous
providers, including the American Hospital Association, CMS maintained the
transparency rule in the final rule, which requires hospitals to report to CMS
the median rate negotiated with Medicare Advantage organizations for inpatient
services. CMS intends to use the data in a new market-based methodology to
set inpatient hospital payments beginning in 2024.

Interim Final Rule on COVID-19 Reportin

85 FR 54820
– This interim final rule
revises regulations to strengthen CMS’s ability to enforce compliance with CMS
long-term care ("LTC") facility requirements for reporting information
related to COVID-19. Specifically, the rule imposes civil money penalty
amounts for an LTC’s failure to electronically report certain COVID-19 data
each week. The rule also establishes new requirements in the hospital and
critical access hospital Conditions of Participation for tracking the
incidence and impact of COVID-19 and sets forth requirements for all Clinical
Laboratory Improvement Amendments (“CLIA”) laboratories to report COVID-19 test
results to the Secretary of Health and Human Services in such form and manner,
and at such timing and frequency, as the Secretary prescribes throughout the
public health emergency.  The rule was published and became effective
on September 9, 2020.

Federal Rule on Breakthrough Technology

85 FR 54327 – CMS
recently issued a proposed rule
establishing a Medicare coverage pathway to provide Medicare beneficiaries
faster access to new, innovative medical devices designated as a breakthrough
by the FDA. The rule proposes a Medicare Coverage of Innovative Technology
("MCIT") pathway, which would begin national Medicare coverage on the
date of FDA market authorization and would continue for four years, covering
services necessary to implant and maintain the devices and any reasonable and
necessary treatments due to complications from the devices. Device
manufacturers would be required to apply to the FDA for breakthrough status,
and then the FDA would review the request to determine whether the device meets
the breakthrough criteria. CMS would subsequently post a list of
breakthrough devices covered through MCIT and the duration of the coverage on
the CMS website. Comments are due on November 20, 2020. CMS issued a fact sheet on the
proposed rule.

The American Medical Association (the
"AMA") Releases 2021 CPT Code Set

On September 1st, 2020, the AMA
released updates to the 2021 Current Procedural Terminology ("CPT")
code set. In total, the AMA announced 329 changes, including 206 new
codes, 54 deletions, and 69 revisions.  These changes reflect a major
overhaul to the codes and guidelines for office and other outpatient evaluation
and management ("E/M") services, such as, eliminating history and
physical exam as elements for code selection. The AMA’s release can be
found here.

Accreditation Association for Ambulatory healthcare (the “AAAHC”) Releases New

The AAAHC has announced
publication of the 41st edition of the Accreditation
Handbook for Medicare Deemed Status
, which contains the most
current information and guidance for organizations seeking accreditation and
best practices for patient safety and care in the ambulatory setting. For
further discussion of the new standard, visit the AAAHC’s webinar series.

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