tci Medicare Compliance & Reimbursement - 2004 Issue 31

Hospitals: CMS Lowers Outlier Threshold In Inpatient Rule

CMS Lowers Outlier Threshold In Inpatient RuleUnder the final Medicare inpatient payment rule for fiscal year 2005, released August 2, hospitals will have an easier time obtaining special payments for treating the most costly Medicare patients. The proposed rule would have made these "outlier" payments harder to obtain. Hospitals receive outlier payments when the cost of treating a particular patient exceeds the available Medicare reimbursement by a sufficient amount, dubbed the "outlier threshold." The payments are intended to counter any incentive to under-treat unexpectedly costly patients that might flow from Medicare's inpatient prospective payment system, which pays...

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