The threshold for hospitals to receive Medicare outlier payments will not change until fiscal 2004 under the final outlier rule issued by the CMS. Hospitals will continue until Oct. 1 to qualify for outlier payments when the cost of an individual case exceeds the standard DRG payment by $33,560. A threshold for 2004, currently proposed at $50,645, will be set when hospital inpatient regulations are issued in August. Regulators will publish the final outlier rule June 9 in the Federal Register; it becomes effective 60 days from publication, on Aug. 8. The final rule also will eliminate the use of statewide average cost-to-charge ratios to determine hospital costs, a move supported by the American Hospital Association. The AHA would like to see a two-year transition to the new outlier rule, but the CMS wants it to take effect sooner. Also under the rule, starting Oct. 1, the CMS will use the most recent cost reports available to calculate outlier payments, even if the cost reports are not yet settled. -- by Jeff Tieman
Outlier threshold to change in Oct.; not yet set
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