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The Useful 5: Regulatory Roundup for Rev Cycle Leaders

Analysis  |  By Amanda Norris  
   May 03, 2023

HealthLeaders' regulatory round up series highlights five essential governing updates that cover every aspect of the revenue cycle that leaders need to know. Check back in each month for more updates.

The revenue cycle is complex, detailed, and always changing, so staying on top of regulatory updates and latest best practices requires revenue cycle leaders' constant attention in this ever-changing industry.

In this revenue cycle regulatory roundup, there were an ample number of updates published by CMS in April, including public health emergency (PHE) updates and multiple payment rate proposals.  

The fiscal year (FY) 2024 inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) PPS proposed rule was released.

On April 10, CMS published a draft copy of the FY 2024 IPPS proposed rule, which is scheduled to be published in the Federal Register on May 1. CMS projects an increase in operating payment rates of 2.8% based on a projected hospital market basket update of 3.0% reduced by a 0.2% productivity adjustment. CMS projects that disproportionate share hospital payments, however, will decrease by approximately $115 million.

Other policies proposed in the rule include:

  • CMS is not proposing to extend the New COVID-19 Treatment Add-On Payments (NCTAP) beyond the previously established end date, which was the end of the fiscal year in which the PHE terminates. With the current plan to end the PHE on May 11, that means NCTAP would expire on September 30. 
  • For the regular New Technology Add-on Payment (NTAP) program, CMS is proposing to move the FDA approval deadline from July 1 to May 1 beginning with applications for FY 2025. CMS is considering 19 applications for NTAP under the traditional pathway and 20 for the alternative pathway for FY 2024.
  • CMS proposed 395 new, 13 revised, and 25 deleted ICD-10-CM codes for FY 2024. Many of these changes apply to W codes for capturing accidents and injuries. Changes also affect codes for Parkinson’s disease, new codes for osteoporosis with pelvic fractures, additional sickle cell anemia codes, and more.  

The rule also contains a variety of quality reporting program changes and changes to graduate medical education payments for training in the new rural emergency hospital provider type. CMS included a Request for Information in the rule regarding challenges faced by safety-net hospitals and ways CMS could help.

CMS published a press release and fact sheet to accompany the rule. Comments are due by June 9.

The FY 2024 inpatient psychiatric facility (IPF) PPS proposed rule was released.

On April 4, CMS released a draft copy of the FY 2024 IPF PPS Proposed Rule, which was published in the Federal Register on April 10. CMS proposes an IPF payment rate update of 1.9% for FY 2024, which is slightly higher than the proposed 1.5% increase for FY 2023.

Other proposals include an amendment to the regulations to allow hospitals to open a new IPF unit at any time during the cost reporting period as long as a 30-day advance notice is provided to the CMS regional office and the MAC. CMS included a Request for Information (RFI) regarding data CMS could collect that could be used to help inform possible revisions to payment rate calculation for FY 2025 and beyond.   

CMS published a fact sheet on the proposed rule on the same date. Comments are due by June 5.

Also published was the FY 2024 skilled nursing facility (SNF) PPS proposed rule.

On April 4, CMS released a draft copy of the FY 2024 SNF PPS Proposed Rule, which was published in the Federal Register on April 10. CMS proposed a 3.7% increase to the SNF payment rate for 2024. This number incorporates the 2.3% reduction that will finish the two-year phase-in of the PDPM parity adjustment.

CMS also included a proposal regarding changes to civil monetary penalties when a facility actively waives its right to a hearing in writing in order to receive a penalty reduction. CMS said that 95% of facilities facing civil monetary penalties currently follow this process. Therefore, CMS said it would create a system in which a failure to submit a timely request for a hearing would be treated as a constructive waiver and the accompanying 35% penalty reduction would remain.

This proposal is intended to reduce the burden involved with tracking and managing written waiver requests. Other proposals in the rule include changes to PDPM ICD-10 code mappings, several quality reporting changes, and SNF value-based purchasing program changes.

CMS published a fact sheet to accompany the rule. Comments are due by June 5.

Resources were published detailing the end of the COVID-19 PHE.

On April 10, CMS updated its COVID-19 Provider Toolkit with information throughout on billing and coding for COVID-19 vaccines and antibody treatments before and after the end of the COVID-19 PHE.

The changes talk about how EUAs are distinct from and not dependent on the PHE itself, review what will happen to payment rates when the EUAs end, payment rates for providing vaccines in a patient’s home through the end of 2023, and more.

More prior authorization requirements were added for facet joint interventions.

On April 11, CMS updated its list of HCPCS codes requiring prior authorization to add facet joint interventions to that list effective July 1, 2023. Providers can start submitting the prior authorization requests on June 15 for dates of service on or after July 1.

Amanda Norris is the Director of Content for HealthLeaders.

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