2023 IPPS proposed rule: CMS weighs changes to reporting programs, rate-setting

May 10th, 2022

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Note:  The following article synopsis was NOT provided by HCPro. It was created by Find-A-Code/innoviHealth.

Article Overview

This article reviews CMS’s fiscal year 2023 Inpatient Prospective Payment System proposed rule and highlights the main areas of proposed change affecting inpatient hospitals. It is aimed at hospital coders, HIM professionals, compliance staff, and reimbursement teams who need to understand the scope of upcoming Medicare policy and reporting updates. The discussion centers on payment rate-setting, MS-DRG methodology, ICD-10-CM/PCS updates, and hospital quality/reporting programs, along with the rulemaking timeline and comment process.

Why This Topic Matters

The proposed rule can affect hospital reimbursement, coding-related data reporting, and quality program participation for the coming fiscal year. Understanding the scope of the proposal helps organizations assess operational impact and prepare comments or implementation plans.

Article Sections

  1. Payment update

    Summarizes the proposed hospital payment update and related market basket and payment adjustment context. Also notes stakeholder reaction to the proposal.

  2. Modified rate-setting

    Describes proposed changes to how CMS would use historical data and account for COVID-19 effects in rate-setting. Includes discussion of related weighting and outlier methodology.

  3. MS-DRG proposals

    Covers CMS’s proposed MS-DRG-related policy areas, including classification review and timing of certain structural changes. Also mentions topics on which CMS is seeking comment.

  4. ICD-10-CM/PCS code updates

    Summarizes proposed annual code set updates and points to the scope of code changes included in the rule. Also references the effective date and supporting tables.

  5. Quality and data reporting

    Reviews proposed changes to hospital reporting requirements and several quality and value-based programs. Also addresses new reporting policies and a proposed hospital designation related to maternity care.

  6. Commenting on the proposed rule

    Provides guidance on reviewing the proposal, focusing on organizational impact and responding to CMS’s requests for comment. Includes the comment deadline and general framing considerations.

What You Will Learn

  • The main policy areas addressed in the FY 2023 IPPS proposed rule
  • How CMS is proposing to approach hospital rate-setting and related adjustments
  • Which hospital quality and reporting programs are being revised
  • What types of ICD-10-CM/PCS changes are included in the proposal
  • How stakeholders can evaluate and respond to the proposed rule

Who Should Read This

  • Hospital coders
  • HIM professionals
  • Inpatient reimbursement staff
  • Compliance teams
  • Hospital revenue cycle leaders
  • Quality reporting staff

Codes Discussed

  • ICD-10-CM: F01.51
  • ICD-10-CM: F02.A11
  • ICD-10-CM: I47.2
  • ICD-10-CM: I71.1
  • ICD-10-CM: S06.0XAA

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