tci Medicare Compliance & Reimbursement - 2003 Issue 23

Hospitals: CMS ISSUES FINAL OUTLIER RULE

Hospitals will have until Oct. 1, 2003, before their most up-to-date cost data is used to calculate "outlier" payments under the final rule issued June 5 by the Centers for Medicare & Medicaid Services. Outlier payments are designed to ensure that hospitals will not stint on care in extraordinarily complex, high-cost cases; they provide higher reimbursement than that associated with the relevant diagnostic-related group under the inpatient prospective payment system. However, some hospital operators, notably Tenet Healthcare, have gamed the system to obtain excessive outlier payments. Until now, Medicare has calculated each hospital's "cost-to-charge" ratio using its most recent...

To read the full article, sign in and subscribe to tci Medicare Compliance & Reimbursement.


Keep pace with evolving Medicare regulations — and onboard your team — with timely analysis of critical updates interpreted in an easy-to-follow, easy-to-apply format. Your subscription to TCI's Medicare Compliance & Reimbursement Alert will equip you to navigate code and guideline changes, CCI edits, and revisions to modifiers, payer policies, the fee schedule, OIG target areas, and more.

  • Current newsletters added each month
  • Fully searchable archives - over 4200 articles
  • ALL years/issues back to 2003 organized by year and issue
  • Codes mentioned in articles are linked to Code Information pages
  • Code Information pages link back to related articles
Access to this feature is available in the following products:
  • tci Medicare Compliance & Reimbursement +Archives

demo
request yours today
 subscribe
start today
 newsletter
free subscription

Thank you for choosing Find-A-Code, please Sign In to remove ads.