tci ED Coding & Reimbursement Alert - 2016 Issue 1

Payment Thresholds in Place for Pass Through Drugs

For 2016, a hospital will be eligible for an outlier payment if its cost of furnishing a service exceeds 1.75 times the APC payment amount and exceeds the APC payment amount plus $3,250.  The payment thresholds this year (2015) are 1.75 times the APC payment amount and a fixed dollar threshold of $2,775. If the cost of a service exceeds both the multiplier threshold and the fixed-dollar threshold, the outlier payment is calculated as 50 percent of the amount by which the cost of furnishing the service exceeds 1.75 times the APC payment...

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