By Jay Moore, M.D.
The recent move by the Centers for Medicare & Medicaid Services (CMS) to reinstate its inpatient-only (IPO) list creates a wealth of opportunities for hospitals.
For the unfamiliar, the IPO list consists of about 300 procedures that CMS will only reimburse if they occur in an inpatient setting. The organization’s rationale for this list has been that these complex procedures are safest and produce the best outcomes when performed in an inpatient setting (i.e., in a hospital operating room).
In 2020, CMS announced plans to phase out the IPO list gradually. The idea was that ambulatory surgery centers (ASCs) could now handle procedures like knee replacements. With the elimination of the IPO list, big insurance companies quickly strengthened policies to push these procedures to outpatient settings.
But in October 2021, CMS announced it was walking this decision back:
“CMS is finalizing its proposal to halt the elimination of the IPO list and add back to the IPO list the services removed in 2021, except for CPT codes 22630 (Lumbar spine fusion), 23472 (Reconstruct shoulder joint), 27702 (Reconstruct ankle joint) and their corresponding anesthesia codes.”
For hospitals, this is good news. Many of the procedures on the IPO list help keep operating margins in the black. And with CMS taking the lead on reinstating the IPO list, insurance companies are under pressure to relax their site of service rules. The result? More procedures in hospital operating rooms for patients with Medicare and commercial insurance.
Of course, hospitals now have to consider how to collect the member portion of payments for these services. High deductibles and lofty out-of-pocket maximums mean patients can be responsible for thousands of dollars of healthcare costs before insurance benefits kick in. This is where Paytient comes in.
By partnering with Paytient, hospitals can help patients access an easy, no-interest line of credit that enables providers to collect the revenue immediately at the time of payment. Paytient holds the credit line, meaning the hospital is held harmless even if collections do not materialize. This is all done at no upfront cost to the hospital, and the result is an immediate doubling of collected revenue.
We are happy to help hospitals navigate these waters. Reach out to our team for more information.
Jay Moore, M.D., is Paytient’s chief clinical officer. He did a combined internal medicine and pediatric residency at the University of Missouri, and he maintains board certification in internal medicine. Jay has worked as a hospital administrator and an insurance executive, where he managed a team of physicians and evaluated startups for partnership opportunities. He lives in St. Louis with his wife and a way-too-large collection of hobby games.