"Panel considers spending caps," Nov. 30, 1998, p. 8, states, "an anomaly in a Medicare statute caused beneficiaries to exceed the usual 20% copayment for outpatient services." This "formula-driven overpayment" caused excess payments directly from Medicare to hospitals. Corrective legislation has no impact on beneficiary liabilities under the cost-based payment scheme; beneficiaries are paying a higher percentage of the allowable amount than in the past. Under the new outpatient prospective payment system, beneficiaries' copayments will eventually approximate 20% of the allowable amount.
HealthEast Compliance, Contracting & Reimbursement
St. Paul, Minn.