CMS Issues CY 2022 Proposed Rules for Medicare Hospital Outpatient Prospective Payment System (HOPPS) and Ambulatory Surgery Center (ASC)

The Centers for Medicare and Medicaid Services (CMS) issued the proposed rule for the Medicare Hospital Outpatient Prospective Payment System (HOPPS) and Ambulatory Surgery Center (ASC) Prospective Payment System. These proposed rules cover outpatient hospital and ASC services furnished to beneficiaries on or after January 1, 2022. Highlights are described below.

For Outpatient Hospital:

  • CMS proposed Conversion Factor of $84.457 for hospitals that meet the hospital outpatient quality (OQR) reporting program requirements; and a CF of $82.810 for hospitals that fail to meet the hospital OQR requirements.
  • CMS proposed payment rates increased by 2.3 percent for hospitals that meet the hospital OQR reporting program requirements; and a continuation of 2.0 percent reduction in payment for hospitals that fail to meet the hospital OQR requirements.
  • CMS proposed to continue 7.1% adjustment factor to payments to certain rural sole community hospitals.
  • No proposed changes to the Ambulatory Payment Classification (APC) payment policy or packaging policy.
  • CMS proposed to continue to use code G0463 for the standardized code on which to base the relative payment weights.
  • CMS proposed to stop elimination of the Inpatient Only List (IOL) and put back the 298 services that were removed as a result of the CY 2021 final rules.
  • CMS proposed to amend several hospital price transparency policies to encourage compliance to this rule.

For Ambulatory Surgery Centers:

  • CMS proposed payment rates increased by 2.3 percent for hospitals that meet the Ambulatory Surgical Center Quality Reporting Program (ASCQR) Program; and a continuation of 2.0 percent reduction in payment for ASCs that fail to meet the ASCQR program requirements.
  • CMS proposed Conversion Factor of $50.043 for ASCs that meet the ASCQR program requirements; and a CF of $49.064 for hospitals that fail to meet the ASCQR program requirements.
  • CMS proposed to re-adopt ASC covered surgical procedures list (ASC CPL) from CY 2020; and remove 258 of the 267 procedures that were added to the ASC CPL as a result of the CY 2021 final rule.

The complete HOPPS/ASC proposed rule summary can be found on the GORE Coding Resource Center website under “Education – CMS Rules Updates”: https://gore.rccsclients.com/education/rules-updates/.