CMS considers eliminating inpatient-only list, expanding prior authorization

Why This Topic Matters

The proposals could affect hospital billing workflows, outpatient service access, payment classification, and compliance planning for the 2021 calendar year and beyond. Stakeholders in hospital revenue cycle, coding, and reimbursement need to understand which services and policy areas are changing and when changes may take effect.

Article Sections

1. Eliminating the inpatient-only list

   Discusses CMS’s proposal to phase out the inpatient-only list and the broader outpatient payment and review implications of removing procedures from that framework.

2. 340B drug reimbursement updates

   Covers proposed updates to hospital reimbursement policy for drugs acquired through the 340B program and the related public comment issues.

3. Prior authorization expansion

   Describes CMS’s planned expansion of outpatient prior authorization categories and the general types of services affected.

4. Physician supervision requirements

   Summarizes proposed changes to supervision standards for outpatient therapeutic services and related flexibilities for certain settings and service types.

5. Device pass-through updates

   Reviews the proposed device pass-through status updates, including the categories of devices under consideration and the agency’s request for comment.

6. Additional information

   Provides references to supporting CMS material, comment timing, and publication notes.