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CMS FINAL RULE TO RESCIND MOST FAVORED NATION (MFN) MODEL INTERIM FINAL FULE
Published in the Federal Register on December 29, 2021 (CMS-5528-F)
This FINAL RULE rescinds the Most Favored Nation Model interim final rule with comment period that appeared in the November 27, 2020, Federal Register. In addition to court cases which delayed implementation, CMS received 1,166 timely pieces of correspondence in response to the November 2020 interim final rule.
Most Favored Nation (MFN) Model (Interim Final Rule with Comments) (CMS-5528-IFC):
Published in the Federal Register on November 27, 2020.
2022 Inpatient Prospective Payment (IPPS) Final Rule: Effective October 1, 2021
2022 IPPS Final Rule (CMS-1752-F)
Federal Register- 8/13/2021: https://www.govinfo.gov/content/pkg/FR-2021-08-13/pdf/2021-16519.pdf
2021 Inpatient Prospective Payment (IPPS) Final Rule: Effective October 1, 2020
2021 IPPS Final Rule (CMS-1735-F)
Federal Register-09/18/2020: https://www.govinfo.gov/content/pkg/FR-2020-09-18/pdf/2020-19637.pdf
Section 1886(d) of the Social Security Act (the Act) sets forth a system of payment for the operating costs of acute care hospital inpatient stays under Medicare Part A (Hospital Insurance) based on prospectively set rates. This payment system is referred to as the inpatient prospective payment system (IPPS). Under the IPPS, each case is categorized into a diagnosis-related group (DRG). Each DRG has a payment weight assigned to it, based on the average resources used to treat Medicare patients in that DRG.
The base payment rate is divided into a labor-related and nonlabor share. The labor-related share is adjusted by the wage index applicable to the area where the hospital is located, and if the hospital is located in Alaska or Hawaii, the nonlabor share is adjusted by a cost of living adjustment factor. This base payment rate is multiplied by the DRG relative weight. Read more.
2021 IPPS Final Rule CORRECTIONS (CMS-1735-CN)
Federal Register- 12/07/2020: https://www.govinfo.gov/content/pkg/FR-2020-12-07/pdf/2020-26698.pdf
Medicare Claims Processing Manual (100-04), Chapter 3- Inpatient Hospital Billing
Acute Care Hospital Inpatient Prospective Payment System MLN booklet (March 2020)
2022 Outpatient Prospective Payment (OPPS) Final Rule: (CMS-1753-FC):
Published in the Federal Register on November 16, 2021
Effective: January 1, 2022
(Read our quick summary here: https://www.pharmacyrevenuecycle.com/newsletter/opps-final-rule-summary-cy2022)
2021 Outpatient Prospective Payment (OPPS) Final Rule: (CMS-1736-F):
Published in the Federal Register on December 29, 2020.
2021 OPPS Final Rule CORRECTIONS (CMS-1736-CN)
Federal Register - 02/25/2021: https://www.govinfo.gov/content/pkg/FR-2021-02-25/pdf/2021-03852.pdf?utm_campaign=subscription+mailing+list&utm_source=federalregister.gov&utm_medium=email
Restated Drug and Biological Payment Rates
Medicare Claims Processing Manual (100-04), Chapter 4- Part B Hospital
Hospital Outpatient Prospective Payment System MLN Booklet (March 2020)
2022 Physician Fee Schedule (PFS) Proposed Rule (CMS-1751-P):
Published in the Federal Register on July 23, 2021.
Comments due to CMS by September 13, 2021.
2021 Physician Fee Schedule (PFS) Final Rule (CMS-1734-F):
Published in the Federal Register on December 28, 2020.
On December 27, 2020, the Consolidated Appropriations Act, 2021 modified the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS). New payment rates are available in the downloads section of the CY 2021 Physician Fee Schedule Final Rule webpage.
HOW TO USE THE SEARCHABLE MEDICARE PHYSICIAN FEE SCHEDULE (MPFS) MLN Booklet (Jan 2020)
Medicare Claims Processing Manual (100-04), Chapter 12-Physicians/Non-Physician Practitioners
2021 Home Health PPS, and Home Infusion Therapy (Final Rules) (CMS–1730–F, CMS–1744–IFC, and CMS– 5531–IFC ):
Published in the Federal Register on November 4, 2020.
Medicare Claims Processing Manual (100-04), Chapter 17- Drugs and Biologicals
Medicare Benefit Policy Manual (100-02), Chapter 15- Covered Medical and Other Health Services, Section 50- Drugs and Biologicals