CMS worked ‘to keep hospital payments as steady as possible’ in inpatient rule

While hospitals must still disclose their negotiated rates with payers, they no longer have to submit cost reports to CMS based on those rates.

May 6, 2021 / Susan Morse, Managing Editor

Healthcare experts, such as Caitlin Sheetz, director and head of Analytics for ADVI, are still combing through everything in the Center for Medicare and Medicaid Services’ Hospital Inpatient Prospective Payment System and Long Term Care Hospital proposed rule released last week.

There’s much for hospitals to like, as the inpatient rule stabilizes reporting requirements to pre-COVID-19 levels and extends add-on payments for 14 technologies.

“Everybody for the most part is pleased,” Sheetz said, though it’s still too early to know what hospitals will be submitting as comments to CMS, due June 28.

One aspect that has gotten the attention of providers is CMS’s repeal of the reporting mandate having to do with hospitals disclosing their privately-negotiated rates with insurers.

Providers loathe the mandate, which went into effect on January 1, as do insurers. Hospitals sued the Department of Health and Human Services over the requirement, and lost. They appealed and lost that too. The U.S. Court of Appeals handed up the ruling on December 29, 2020, days before they were mandated to disclose their standard charges, including payer-specific negotiated rates, for 300 shoppable services. The only leeway hospitals received was a year’s delay on when the 2019 rule would go into effect: from January 1, 2020 to January 1, 2021.


Chris J. Stewart

Chris currently serves as President and CEO of Surgio Health. Chris has close to 20 years of healthcare management experience, with an infinity to improve healthcare delivery through the development and implementation of innovative solutions that result in improved efficiencies, reduction of unnecessary financial & clinical variation, and help achieve better patient outcomes. Previously, Chris was assistant vice president and business unit leader for HPG/HCA. He has presented at numerous healthcare forums on topics that include disruptive innovation, physician engagement, shifting reimbursement models, cost per clinical episode and the future of supply chain delivery.

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