The Centers for Medicare & Medicaid Services (CMS) finalized the 2022 OPPS ASC Final Rule, introducing significant policy and payment changes for hospitals and Ambulatory Surgical Centers (ASCs). Effective January 1, 2022, the rule increases Medicare payment rates, strengthens hospital price transparency enforcement, revises the Inpatient Only (IPO) List, updates quality reporting programs, and expands reimbursement for select services.
These changes have important implications for healthcare providers, revenue cycle management teams, and hospital billing professionals.
CMS Increases Medicare Payment Rates
CMS finalized a 2% payment increase for hospitals that successfully meet Hospital Outpatient Quality Reporting (OQR) Program requirements.
The update is based on:
- 2.7% projected hospital market basket increase
- 0.7% productivity adjustment
Hospitals and ASCs that fail to meet quality reporting requirements remain subject to a 2% payment reduction.
CMS estimates total Medicare payments for Calendar Year (CY) 2022 will reach approximately:
- $82.1 billion for OPPS providers
- $5.4 billion for Ambulatory Surgical Centers
CMS Uses 2019 Claims Data for 2022 Rates
Because the COVID-19 Public Health Emergency significantly affected healthcare utilization during 2020, CMS determined that 2020 claims data did not accurately reflect normal outpatient service patterns.
Instead, CMS used Calendar Year 2019 claims data to establish OPPS and ASC payment rates for 2022.
Stronger Hospital Price Transparency Enforcement
One of the most significant provisions in the 2022 OPPS ASC Final Rule is the substantial increase in civil monetary penalties (CMPs) for hospitals that fail to comply with hospital price transparency requirements.
Updated Financial Penalties
Beginning January 1, 2022:
- Minimum annual penalty: $109,500
- Maximum annual penalty: $2,007,500
- Daily penalty for hospitals with more than 30 beds: $10 per bed
- Maximum daily penalty: $5,500
- Maximum daily penalty for hospitals with 30 or fewer beds: $300
CMS also updated technical requirements to ensure hospitals make machine-readable pricing files accessible for automated searches and direct downloads.
Additionally, state forensic hospitals that exclusively treat individuals in correctional custody are considered compliant with the transparency regulations.
CMS Reverses Elimination of the Inpatient Only List
CMS reversed its previous decision to phase out the Inpatient Only (IPO) List, citing patient safety concerns and the need for further evaluation.
The agency:
- Halted the elimination of the IPO List.
- Reinstated 293 of the 298 procedures removed during CY 2021.
- Retained removal of only five procedures that met CMS safety and clinical criteria.
CMS also provided temporary protection from:
- Site-of-service claim denials
- Recovery Audit Contractor (RAC) reviews
- Two-Midnight Rule enforcement
for qualifying procedures removed from the IPO List beginning in 2022.
Changes to the ASC Covered Procedures List
CMS reinstated patient safety criteria for procedures eligible for the Ambulatory Surgical Center Covered Procedures List (ASC CPL).
Key updates include:
- Removal of 255 procedures added during CY 2021.
- Introduction of a formal nomination process allowing external stakeholders to recommend future ASC procedures beginning in March 2022.
This process is intended to improve transparency while maintaining patient safety.
340B Drug Payment Policy Remains
CMS continues to reimburse certain 340B-acquired drugs at:
Average Sales Price (ASP) minus 22.5%
However, several provider types remain exempt, including:
- Rural Sole Community Hospitals
- Children’s Hospitals
- PPS-Exempt Cancer Hospitals
Separate Payment for Non-Opioid Pain Management Products
CMS expanded reimbursement by allowing separate payment for qualifying non-opioid pain management drugs and biological products used during surgical procedures in the ASC setting.
Eligible products must:
- Receive FDA approval
- Be indicated for pain management or analgesia
- Exceed the OPPS drug packaging cost threshold
This policy supports safer postoperative pain management while reducing opioid use.
Colorectal Cancer Screening Coinsurance Changes
Beginning January 1, 2022, Medicare considers flexible sigmoidoscopies and colonoscopies to remain screening services even when tissue removal or biopsy occurs during the procedure.
As a result, related surgical services performed during the same clinical encounter are treated as part of the screening service when calculating beneficiary coinsurance.
Hospital Outpatient Quality Reporting Updates
CMS finalized several improvements to the Hospital Outpatient Quality Reporting (OQR) Program, including:
- Adding three new quality measures
- Introducing COVID-19 vaccination reporting for healthcare personnel
- Making previously voluntary measures mandatory
- Removing outdated quality measures
- Streamlining validation processes to reduce administrative burden
ASC Quality Reporting Program Changes
The Ambulatory Surgical Center Quality Reporting (ASCQR) Program also received several updates.
CMS finalized:
- Mandatory reporting of COVID-19 vaccination among healthcare personnel
- Required reporting of six previously voluntary or suspended quality measures
These changes support national quality improvement initiatives while increasing accountability across outpatient surgical facilities.
Industry Response
Healthcare organizations generally welcomed CMS’s decision to preserve the Inpatient Only List and recognize the unique role of hospital outpatient departments.
However, industry leaders continued to express concerns regarding ongoing payment reductions for hospitals participating in the 340B Drug Pricing Program, citing potential impacts on patient access and community healthcare services.
What Hospitals Should Do Now
Healthcare organizations should prepare for the 2022 OPPS ASC Final Rule by:
- Reviewing updated Medicare reimbursement policies.
- Ensuring compliance with hospital price transparency requirements.
- Updating chargemasters and machine-readable pricing files.
- Verifying quality reporting program participation.
- Monitoring IPO List and ASC Covered Procedures List revisions.
- Educating billing and compliance teams on new CMS policies.
- Strengthening revenue cycle processes to minimize compliance risks and payment disruptions.
Conclusion
The 2022 OPPS ASC Final Rule introduces significant Medicare payment and compliance changes that directly affect hospitals and Ambulatory Surgical Centers. From higher payment rates and expanded quality reporting to dramatically increased hospital price transparency penalties, these updates require healthcare organizations to review billing practices, strengthen compliance programs, and stay current with CMS regulations to ensure accurate reimbursement and avoid costly penalties.