T he Centers for Medicare & Medicaid Services (CMS) has released its 2021 Outpatient Prospective Payment System (OPPS) final rule. This release includes some of the major updates like increasing Medicare outpatient costs by 2.4%, while also phasing out the inpatient only list, among many other amends. Here are the five key takeaways that capture the essence of the 1,312-page report.

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Key Takeaways from the 2021 OPPS Final Rule

1. Inpatient only list.
   CMS will be removing the inpatient only list (nearly 300 services majorly in the musculoskeletal area) by 2024. These procedures that are eliminated will no more be included in Medicare site-of-service claim denials.
2. 340B Program.
   On account of the global health crisis, CMS has announced that it will continue the existing policy that pays hospitals about 23% lesser than the average sales price for 340B drugs.
3. Prior Authorization.
   From the mid of 2021, CMS will implement prior authorization for key specializations including cervical fusion and implanted spinal neurostimulators.
4. Hospital Reporting.
   CMS has also placed a new requirement that all the hospitals in the U.S report critical information on their inventory of therapeutics for COVID-19. CMS adds that this information is critical in meeting the surging needs of COVID-19 care and reiterates that it helps in tracking, monitoring and allocating therapeutics to hospitals in need of additional inventory.
5. Star Ratings.
   The Final rule also mentions about revisions to the way in which star ratings are provided to the hospitals. This will include revisions based on measure group scores by calculating the simple average.
6. Telemedicine.
   The global health emergency has given rise to the increasing adoption of Telemedicine solutions and services that have gained tremendous importance over the last few months. CMS had also throughout the year introduced new policy changes and made several announcements around relaxations for telemedicine and remote patient monitoring services.

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Here are the top highlights of CMS updates on Telemedicine solutions and digital healthcare services.March 2020 – CMS announced separate payments for telephonic Evaluation and Management (E&M) Services. However, the agency proposes that these are the temporary functions enabled to facilitate telehealth and remote patient monitoring services, as a safer and secure alternative to care provision during the public health emergency. CMS also seeks comments and suggestions on if these telemedicine guidelines should be made permanent for extended benefits in the long run.

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