IHA Daily Briefing: November 11

IHA Releases CY 2027 Medicare OPPS Top 10 List

On Nov. 6, the Centers for Medicare & Medicaid Services (CMS) published its calendar year (CY) 2027 Medicare Outpatient Prospective Payment System (OPPS) final rule. CMS finalized a rate increase of 2.3% relative to CY 2026 for both hospitals paid under the OPPS and Ambulatory Surgical Centers. This reflects a 3.2% market-basket update and a 0.9 percentage point productivity cut.

CMS finalized several policies that will impact hospital reimbursement and operations. IHA encourages you to review our CY 2027 Medicare OPPS Top 10 List, which lists 10 finalized policies of interest to the hospital community. IHA will release a more detailed OPPS fact sheet and CY 2026 OPPS facility-specific estimated financial impact reports via the IHA C-Suite. A CMS fact sheet providing additional details is available here.

Staff contact: Cassie Yarbrough

HIPAA Enforcement Discretion Issued in Response to 2027 Maternity Care Services CPT Codes Changes

The Current Procedural Terminology (CPT) Editorial Panel recently approved a significant restructuring of maternity care services codes for the CPT 2027 code set they say are intended to better reflect modern obstetric practice, facilitate improved data transparency and quality, and support evidence-based maternity care. As a result, beginning Jan. 1, 2027, the American Medical Association (AMA) will delete 17 global and traditional maternity CPT codes, replacing them with a framework that will allow care to be reported more granularly at the service level, separately identifying four phases of care: antepartum, labor management, delivery and postpartum.

The U.S. Dept. of Health and Human Services recognizes that this timeline will create billing conflicts for pregnancies that begin in 2026 and deliver in 2027. To smooth this transition, from Jan. 1, 2027 through Dec. 31, 2027, HHS recently announced it will not take HIPAA enforcement action against covered entities that use 2026 maternity CPT codes outside their standard date range, provided they follow specific business rules and instructions issued by their payers or health plans. However, CMS stated it will not require all commercial or Medicaid/Medicare payers to accept old codes, making it critical practices verify individual payer rules to avoid claim denials or delayed payments. Click here for more information on the CPT 2027 maternity service code changes, including an overview of the changes, implementation recommendations and other pertinent information.

REGISTER: IDPH to Lead IHA Antibiotic Awareness Week Webinar Nov. 20

Antibiotic Awareness Week, Nov. 18-24, calls on healthcare professionals to recommit to a coordinated actions to curb drug-resistant infections. Make IHA's complimentary webinar, "Stewardship in Action: Antibiotic Awareness Week and Honor Roll Recognition," a part of your Antibiotic Awareness Week plans. The Illinois Dept. of Public Health (IDPH) will lead the Nov. 20 session from 10-11 a.m. CT, focusing on antimicrobial initiatives hospitals and health systems can adopt to enhance patient care and outcomes. The session is exclusively for IHA members.

IDPH leaders will also recognize the successful efforts of Illinois hospitals in addressing antimicrobial resistance. They'll announce the Illinois hospitals receiving the 2026 Antimicrobial Stewardship Collaboration Distinction award and those that made the 2026 Acute Care Antimicrobial Stewardship Honor Roll. The honor roll reflects efforts to implement the Centers for Disease Control and Prevention's core elements of hospital antibiotic stewardship programs, which IDPH says less than 10% of hospitals have reported completing successfully.

The webinar will benefit pharmacists, quality improvement leaders, patient safety and risk management leaders, CNOs, and CMOs. There is no fee to attend. Registrants will receive the webinar recording; you can view the webinar later if you can't attend the live session. Register today.

Staff contact: Jenny Winkler

REMINDER: Informational Meeting on RHTP NOFO for EMS Initiative

Last week, Illinois Dept. of Public Health (IDPH) released a Notice of Funding Opportunity (NOFO) for the Rural Health Transformation Program's (RHTP) Emergency Medical Services (EMS) initiative. Of the $16.5 million allocated to IDPH in first-year funding, $13.5 million is available through a competitive grant opportunity for 15 Illinois-designated EMS Resource Hospitals, with each selected hospital to receive approximately $978,000. As a reminder, IDPH will host an optional informational meeting tomorrow, Nov. 12, from 2-3 p.m. CT to answer questions about the funding opportunity. Interested hospitals can join the meeting here.

Click here to access the NOFO and grant listing, which provides additional information on eligibility, allowable expenses, application requirements, and evaluation criteria. Click here to access an IHA fact sheet with links to information, resources, and guidance on the RHTP and associated grant funding opportunities.

Staff contact: Jordan Powell

Illinois Respiratory Disease Surveillance Data

The Infectious Respiratory Disease Surveillance Dashboard from the Illinois Dept. of Public Health (IDPH) provides the latest data on hospital visits, seasonal trends, lab test positivity and demographic data. IDPH also tracks COVID-19, influenza and respiratory syncytial virus information through the Illinois Wastewater Surveillance System dashboard.

Briefly Noted

Intersurgical Inc. is recommending the removal of certain breathing systems because of the possibility of an insecure connection that could compromise ventilation. As of Nov. 3, Intersurgical has reported no serious injuries or deaths associated with this issue.

Arrow International, a subsidiary of Teleflex Incorporated, is also recommending the removal of certain products that contain Spring Wire Guide components because of a potential quality issue that may cause particles to be released into the blood stream. As of Nov. 5, Arrow International has reported no serious injuries or deaths associated with this issue.

Leading the News