tci Medicare Compliance & Reimbursement - 2008 Issue 36

Reimbursement: Feds' Fraud Fight Will Reduce Outlier Rate

CMS punts on wage index yet again. The 2009 home health agency rate update notice does contain one piece of good news in an unexpected area. Under the current 0.89 fixed dollar loss (FDL) ratio for outlier calculations, the Centers for Medicare & Medicaid Services expects outlier payments to reach 8.1 percent in 2008. That's well above the 5 percent they are supposed to make up, CMS points out in the 2009 PPS rate update notice in the Nov. 3 Federal Register. If CMS kept the current FDL ratio and provider payment patterns stayed the same, outlier...

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