The Centers for Medicare and Medicaid Services proposed a new rule for outlier payments under which Medicare would collect any amount surpassing the actual cost of care. Outlier payments compensate hospitals for cases exceeding the Medicare DRG rate by a certain threshold, currently $33,560. They are at the center of a federal investigation into Tenet Healthcare Corp., Santa Barbara, Calif., and the CMS has been expected to issue a new rule to eliminate perceived abuses. The current threshold would continue under the CMS' proposed rule, but hospitals would be required to return payments above the actual cost of care. The proposed rule also would end the use of statewide averages in calculating payments and allow Medicare to use more recent data. The rule is subject to a 30-day comment period. -- by Jeff Tieman
CMS proposal would limit outlier payments to costs
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