The Centers for Medicare & Medicaid Services (CMS) released in its 2025 Outpatient Prospective Payment System (OPPS) Final Rule a new Conditions of Participation (CoPs) for hospitals and Critical Access Hospitals (CAHs) offering obstetrical (OB) services.
This initiative is part of the CMS strategy to improve maternal health outcomes, particularly considering the United States’ ongoing maternal health crisis, which has resulted in some of the highest maternal mortality rates among high-income countries worldwide, disproportionately affecting communities of color.
The proposed CoP generally defines some of the coming provisions that will be expected in the coming document, so hospitals can start preparing.
Organization and Staffing: CMS has finalized requirements ensuring that OB services are well-structured, adhering to nationally recognized standards. The OB care department/unit must integrate with other departments in the facility, and OB patient care units must be supervised by qualified personnel, such as experienced registered nurses, certified midwives, nurse practitioners, or physicians. The granting of OB care privileges must follow written criteria, ensuring that only appropriately credentialed practitioners provide OB services.
Delivery of Services: To ensure the effective and timely treatment of obstetrical cases, CMS requires that facilities maintain essential OB equipment, such as fetal monitors and cardiac equipment. The level of equipment should reflect the facility’s volume and complexity of OB services. CMS recognizes that low-volume facilities may need fewer resources, compared to high-volume ones, allowing for flexibility while maintaining minimum standards. The requirements also include having protocols consistent with evidence-based guidelines for OB emergencies, ensuring comprehensive preparedness.
Staff Training: CMS mandates that hospitals and CAHs develop training policies tailored to the scope of services offered. This training must be evidence-based and informed by the facility’s Quality Assessment and Performance Improvement (QAPI) programs. New staff must receive initial training, and relevant existing staff must complete training every two years. This approach aims to maintain a high level of competence in maternal care delivery across all staff.
Quality Assessment and Performance Improvement (QAPI) Program: CMS is requiring hospitals and CAHs to use their QAPI programs to address health disparities among OB patients. Facilities must analyze data and quality indicators across different subpopulations; measure and track patient outcomes; and prioritize initiatives to reduce disparities. At least one performance improvement project focusing on OB patient outcomes is required annually. Additionally, facilities must incorporate information from Maternal Mortality Review Committees (MMRCs) where available, integrating public data to enhance their QAPI programs.
Enhancements in Emergency Services Readiness: CMS has revised emergency readiness standards, requiring hospitals and CAHs to have provisions aligned with nationally recognized guidelines for treating emergency patients, including pregnant and postpartum women. This includes maintaining essential emergency supplies, such as drugs and equipment necessary for lifesaving procedures. Staff training on these protocols is mandatory, with annual documentation of successful completion.
Discharge Planning Requirements: CMS is recommending adding Transfer Protocols to § 482.43. However, they will be including mandates that hospitals establish comprehensive written policies covering intra-hospital transfers and transfers between facilities. This would be inclusive of hospital inpatients (for example, transfers from the emergency department to inpatient admission, transfers between inpatient units in the same hospital, or transfers between inpatient units at different hospitals). Annual training on these protocols will be included in the emergency readiness standards, as it appears that final determination on this requirement is not yet solidified.
To accommodate feedback and address concerns about the potential burden of these new requirements, CMS is implementing the CoPs in three phases over two years:
These new CoPs reflect the CMS commitment to addressing the maternal health crisis through enhanced quality and safety standards for OB services. By implementing these standards, CMS aims to reduce maternal mortality, improve health equity, and ensure consistent, high-quality care for pregnant, birthing, and postpartum patients across the United States.
Now is the time for hospitals with OB services to start preparing for these standards to ensure they are meeting all the CMS requirements as they are released.
Programming note: (REGISTRATION LINK)
Listen to Tiffany Ferguson report this story live today during Talk Ten Tuesday with Chuck Buck and Dr. Erica Remer.
While it is not in the news on a daily basis any longer, COVID has not gone away. Since the start of the pandemic, we
There has been a noticeable increase in payer actions regarding readmission denials, often justified as efforts to enhance quality of care and align with Medicare’s
Please log in to your account to comment on this article.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.
Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
Enhancing outpatient clinical documentation is crucial for maintaining accuracy, compliance, and proper reimbursement in today’s complex healthcare environment. This webcast, presented by industry expert Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, will provide you with actionable strategies to tackle complex challenges in outpatient documentation. You’ll learn how to craft detailed clinical narratives, utilize advanced EHR features, and implement accurate risk adjustment and HCC coding. The session also covers essential regulatory updates to keep your documentation practices compliant. Join us to gain the tools you need to improve documentation quality, support better patient care, and ensure financial integrity.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks. Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.
Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.
During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.
Copyright © 2024 ICD10monitor. Powered by MedLearn Media.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
