In an unprecedented move, the Centers for Medicare & Medicaid Services (CMS) has proposed in the 2022 Outpatient Prospective Payment System (OPPS) Rule to put back on the inpatient only list all the procedures that they removed from the inpatient only list starting this calendar year.
The agency has also put a halt to its three year-plan to completely eliminate the inpatient only list. It appears that its motivation is to protect the safety of Medicare beneficiaries and take a more cautious approach to removing services from the inpatient only list looking at them on a n individual basis rather than by class.
“Since there are still five months left in the year, it is unclear what physicians and hospitals should do with this information now,” said Ronald Hirsch, MD, vice president of regulations for R1 RCM Inc. “Since the audit moratorium remains in place for all of the procedures removed this year, and CMS has admitted proceeding too quickly with the removal process, it may be reasonable to tell physicians to disregard the complicated decision-making process that we wanted them to undertake and go back to admitting everybody as an inpatient starting today.”
On the other hand, cautioned Hirsch, “is it a compliance issue to ignore the status recommendations that are still technically and legally in place? I think this is a question that every compliance officer in the country is going to have to assess and decide upon very quickly.”
Stay here for more breaking news.
The full proposed rule can be found at: https://public-inspection.federalregister.gov/2021-15496.pdf
There are few perfect things in this world, and hospital operations are not one of them. While multitudes of individuals – clinical and non-clinical –
You have heard Dr. Ronald Hirsch, and I present on CMS-4204-F which introduces a process for expedited determinations for traditional Medicare beneficiaries who are reclassified
Please log in to your account to comment on this article.
Stop revenue leakage and boost hospital performance by mastering risk adjustment and HCCs. This essential webcast with expert Cheryl Ericson, RN, MS, CCDS, CDIP, will reveal how inaccurate patient acuity documentation leads to lost reimbursements through penalties from poor quality scores. Learn the critical differences between HCCs and traditional CCs/MCCs, adapt your CDI workflows, and ensure accurate payments in Medicare Advantage and value-based care models. Perfect for HIM leaders, coders, and CDI professionals. Don’t miss this chance to protect your hospital’s revenue and reputation!
Struggling with ICD-10-CM coding for diabetes and complications? This expert-led webcast clarifies complex combination codes, documentation gaps, and sequencing rules to reduce denials and ensure compliance. Dr. Angela Comfort will provide actionable strategies to accurately link diabetes to complications, improve provider documentation, and optimize reimbursement—helping coders, CDI specialists, and HIM leaders minimize audit risks and strengthen revenue integrity. Don’t miss this chance to master diabetes coding with real-world case studies, key takeaways, and live Q&A!
Uncover critical guidance. HIM coding expert, Kay Piper, RHIA, CDIP, CCS, provides an interactive review on important information in each of the AHA’s 2025 ICD-10-CM/PCS Quarterly Coding Clinics in easy-to-access on-demand webcasts, available shortly after each official publication.
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s fourth quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
RACmonitor is proud to welcome back Dr. Ronald Hirsch, one of his most requested webcasts. In this highly anticipated session, Dr. Hirsch will break down the complex Two Midnight Rule Medicare regulations, translating them into clear, actionable guidance. He’ll walk you through the basics of the rule, offer expert interpretation, and apply the rule to real-world clinical scenarios—so you leave with greater clarity, confidence, and the tools to ensure compliance.
Bring your questions and join the conversation during this open forum series, live every Wednesday at 10 a.m. EST from June 11–July 30. Hosted by Chuck Buck, these fast-paced 30-minute sessions connect you directly with top healthcare experts tackling today’s most urgent compliance and policy issues.
Fraud convictions don’t just punish a few bad claims; they can wipe out years of reimbursements. Don’t wait for an audit to learn the rules. Join Frank Cohen, MPA, for a live Q&A on spotting red flags, avoiding liability, and protecting your practice. Register now and bring your questions!
Substance abuse is everywhere. It’s a complicated diagnosis with wide-ranging implications well beyond acute care. The face of addiction continues to change so it’s important to remember not just the addict but the spectrum of extended victims and the other social determinants and legal ramifications. Join John K. Hall, MD, JD, MBA, FCLM, FRCPC, for a critical Q&A on navigating substance abuse in 2025. Register today and be a part of the conversation!
Copyright © 2025 ICD10monitor. Powered by MedLearn Media.
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
This Memorial Day, we honor those who gave all for our freedom. Take 20% off sitewide through May 31 with code MEMORIAL25 at checkout
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
