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.
SHHIPS is based upon the successful outlier payment limit, which was proposed by the home health community and implemented in 2010.
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.
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.
These reforms are based on a 2009 outlier payment reform, which is on track to achieve $11 billion in savings over 10 years.
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.
Models that better match costs modestly decrease this risk, and the retrospective payment model and the outlier payment policies reduce risk most
These reforms are based on outlier payment reform, which was successfully implemented in 2010 and is on track to achieve more than $11 billion in savings over a 10-year period.
The analogous high-cost outlier payment is a fraction of costs after the case passes a threshold.