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Medicare Inpatient Only List Explained

Medicare Inpatient Only List Explained. Medicare has a list of approximately 1,800 procedure codes for procedures that it will ONLY pay for on an inpatient basis. These tend to be more invasive surgeries such as a coronary artery bypass graft (CABG). However, starting in 2021 CMS starting removing procedures from the Inpatient Only List, meaning these procedures can now be paid for on a outpatient basis at an Ambulatory Surgery Center (ASC). Two of the most important surgeries to come OFF the Inpatient Only List are Total Knee and Total Hip Replacements. As a result, much of hospital revenue is moving from inpatient to outpatient. Major hospital systems are dramatically growing their ASCs so that competing ASCs do not take their patient volume. Hospital System Owned ASCs still have very high reimbursement rates from Commercial Insurance for patients on an employer-sponsored health plan. Just because the procedure is at an ASC, that DOES NOT mean it is inexpensive. Rather for employer-sponsored insurance plans, it is to their advantage to have plan members have outpatient surgery performed at an Independent ASC that is not owned by a major hospital system. For example, the NTTC ASC in the Dallas Area charges $20,000 as a bundled price for a total knee replacement vs. over $70,000 for the same procedure at a hospital-owned ASC. Sources: Medicare Inpatient Only List: https://www.cms.gov/node/1275841 https://www.cms.gov/medicare/payment/... CMS Hospital Outpatient Regulation: https://www.govinfo.gov/content/pkg/F... American College of Physician Advisors: https://www.acpadvisors.org/ HCA ASCs: https://www.beckersasc.com/asc-news/h... Tenet ASCs: https://www.beckershospitalreview.com... https://www.beckershospitalreview.com... https://www.reuters.com/article/idUSK... https://www.nttcsurgerycenter.com/pro... AHealthcareZ is 400+ Healthcare Finance Educational Videos. 💥 BOOK: Check out Dr. Bricker’s Book 16 Lessons in the Business of Healing here: https://www.ahealthcarez.com/healthca... AHealthcareZ Viewers Include: Employee Benefits Professionals, HR, CFOs, Insurance Brokers, Benefits Consultants, Doctors and Nurses in Leadership Roles, Hospital and Health System Administrators, Health Insurance Carrier and PBM Professionals, Pharma and Med Device Professionals, Academic Professors and Students in Healthcare Administration and Public Health. 90,000+ Views Per Month Across All Platforms. Visit AHealthcareZ.com to Subscribe to the Healthcare Finance Video Newsletter.