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.
Effects of the ten percent cap in Medicare Home Health care on treatment intensity and patient discharge status
With the exception of DVT/PE, outlier payment differences are higher than the payment differences for the base MS-DRG payments.
The impact of hospital-acquired conditions on Medicare program payments
High average outlier payment amount per beneficiary.
HHS Watchdogs: Home Health Smells
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 issued final rule in late July that changes how dialysis services will be paid for by medicare
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 to stop paying for 'preventable' events
Claims that Tenet Healthcare fraudulently abused the Medicare outlier payment system resulted in a high-profile $900 million fine.
Medicare advantage: as enrollment grows, so do risks for plans
Medicare sets the outlier payment formula based on the most recent Medicare cost report submitted by the hospital.
PeaceHealth gives back $13.3 million
The HH PPS allows for additional payment for unexpectedly high utilization cases through an outlier payment if the episode exceeds a threshold amount.
Medicare's home health prospective payment system. (FEATURED CME TOPIC: THE OLDER PATIENT)
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.
Estimation of standardized hospital costs from Medicare claims that reflect resource requirements for care: impact for cohort studies linked to Medicare claims
The outlier payment provisions of the Medicare inpatient prospective payment system were a key component of its ultimate success.
Bundling post-acute care services into MS-DRG payments
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).
Adverse selection, moral hazard, and outlier payment policy
Hospitals can also qualify for additional payments under outlier payment policies, depending on the hospital's actual charges.
Medicare to pay for LVAD in heart patients not eligible for a transplant
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