CMS 2021 IPPS FINAL RULE
CMS released its annual update to the Inpatient Prospective Payment System on September 2, 2020. The new rule takes effect on October 1, 2020. While the rule is a whopping 2160 pages long, MRS has done the research and here are the key points coders need to know.
1. 2.9% net payment rate increase – This little financial boost applies to all IPPS hospitals who report quality measure data and are meaningful use EMR users. There is a caveat however. These hospitals must disclose payer-negotiated rates for inpatient services by MS-DRG for Medicare Advantage organizations. Beginning in FY 2024, CMS will use this data to develop a new market-based methodology to set MS-DRG relative weights.
2. DSH payments lose – For FY 2021 CMS will decrease its disproportionate share hospital payments by $60.6 million compared to FY 2020. DSH payments are additional funds paid to hospitals who provide high volumes of uncompensated care. This year CMS will use 2017 data to determine a hospital’s DSH payment eligibility and the amount of the DSH payment.
3. Add-on Payments – Twenty-four new technologies and a limited number of new antimicrobial drugs are eligible for add-on payments in FY 2021. CMS estimates that FY 2021 Medicare spending on add-on payments will be approximately $874 million, nearly a 120% increase over the FY 2020 spending. Check out the new codes in the New Technology section of ICD-10-PCS.
4. New DRG – 018 is the new MS-DRG for CAR T-cell therapy. car-T is an adoptive cell immunotherapy approved for some forms of aggressive, refractory non-Hodgkin’s lymphoma and for patients with relapsed or refractory acute lymphoblastic leukemia up to age 25. The new DRG has a weight of 37.14.
5. Inpatient quality reporting – Starting with 2021 data, CMS will gradually increase the number of quarters of reported electronic clinical quality measure data (eCQM) until it reaches a full year for the 2023 reporting period. CMS also will begin publicly reporting eCQM measure results in late 2022, starting with data from CY 2021.
Official resources and links are provided for your reading pleasure below. The CMS Final Rule Home Page is the link I personally find most helpful. Each year I download the new MS-DRG table (Table 5) and updated CC and MCC lists (Tables 6A-6K).
If you want an overview of all the coding and DRG changes coming up on October 1st, please visit our website: https://www.mrsnh.com and sign up for our free webinar. It’s prerecorded and available to you on demand. Enjoy!
Resources and links:
CMS Newsroom Fact Sheet:
Federal Register Final Rule (publishing date 9/18/20):
CMS Final Rule Home Page:
https://www.cms.gov/medicare/acute-inpatient-pps/fy-2021-ipps-final-rule-home-page
https://www.cms.gov/files/zip/fy-2021-ipps-fr-table-5.zip
https://www.cms.gov/files/zip/fy-2021-ipps-fr-tables-6a-6k-6p.zip