tci Medicare Compliance & Reimbursement - 2004 Issue 43

Hospitals: Final Outpatient Rule Increases Outlier Thresholds

Why it'll be harder than ever for hospitals to get extra reimbursement for costly cases.Under Medicare's final 2005 hospital outpatient payment rule, it will be harder for hospitals to get extra payments for particularly expensive patients than it would have been under the proposed rule. The rule gives hospitals a 3.3-percent update to payments under the outpatient prospective payment system. That's a full "market-basket" update, fully reflecting inflation in the cost of goods and services that go into providing outpatient care. Overall, the Centers for Medicare & Medicaid Services expects hospital outpatient payments to increase from...

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