outlier payment

outlier payment

An adjustment to the tariff paid to an institution for a particular package of healthcare services in the UK, which is triggered when a patient stays for much more (long-stay addition) or much less (short-stay subtraction) time than the “average” patient.
References in periodicals archive ?
In response, insurers have increased monitoring of outlier payments and cut outlier payment rates (Baser et al.
With the exception of DVT/PE, outlier payment differences are higher than the payment differences for the base MS-DRG payments.
High average outlier payment amount per beneficiary.
The final rule also includes an outlier payment policy that will pay facilities more for patients whose care is significantly more costly than the Medicare payment amount.
CMS will continue to use the hospital's total charges for all inpatient services provided during a patient's stay when determining whether the case qualifies for an outlier payment.
Claims that Tenet Healthcare fraudulently abused the Medicare outlier payment system resulted in a high-profile $900 million fine.
Medicare sets the outlier payment formula based on the most recent Medicare cost report submitted by the hospital.
Equations 7 and 8 are the same as Equations 2 and 3 except that standard based amounts without geographic adjustment are used and outlier payment is added.
The outlier payment provisions of the Medicare inpatient prospective payment system were a key component of its ultimate success.
According to McClellan (1997), the effects of the outlier payment system on the power of the PPS are substantially larger than might be conveyed by its 5 percent share (see Newhouse, 2002).
Hospitals can also qualify for additional payments under outlier payment policies, depending on the hospital's actual charges.