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Resources Available to Support AHA Members in Interpreting CMS Medicare FFY 2021 IPPS Final Rule

Earlier this month, CMS released the FFY 2021 Medicare Inpatient Prospective Payment System (IPPS) final rule. The final rule reflects the annual updates to the Medicare fee-for-service inpatient payment rates and policies. In addition to the regular updates to wage indexes and market basket, this rule includes:

  • A rate increase amount (+0.5%) for the Coding Offset adjustment;
  • Changes to CBSA delineations;
  • Updates to the Medicare Disproportionate Share Hospital (DSH) payment policies including hospitals will be eligible for DSH payments in FFY 2021 based on audited FFY 2017 S-10 data;
  • Requiring hospitals to report the median payer-specific negotiated rates for inpatient services, by MS-DRG, for Medicare Advantage organizations on the Medicare cost report;
  • Creating a new MS-DRG for CAR-T therapy;
  • Updates to the program rules for the Value-Based Purchasing (VBP), Readmission Reduction Program (RRP) and Hospital-Acquired Condition (HAC) programs; and
  • Updates to the payment penalties for non-compliance with the Hospital Inpatient Quality Reporting (IQR) and Electronic Health Record (EHR) Incentive Programs.

We have provided IPPS-participating members with a customized report showing estimates of each hospital’s Medicare payment under the final rule. Reports were sent to CEOs and CFOs on Sept. 23, and are also available on the AHA Analytics website.

Our analysts at DataGen will be providing a webinar at 2 p.m. CST on September 30, to go over the prepared report, as well as summarize the major points of the final rule. Registration is required, and you may register here. A recording of the webinar can also be provided, if you are unable to attend live.

Please contact Melanie Thomasson, AHA Director of Data, with any questions or for more information.