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 ?
Del-Bene's bill would increase the NTAP payment amount from 50 percent to 80 percent to align with the Medicare outlier payment rate; expand certain NTAP criteria definitions so more new technologies are eligible for and receive the add-on; and establish a formal appeals process for manufacturers denied an NTAP determination.
Improvements to Medicare's NTAP for New, Innovative Medical Devices
* 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
This study explores how Medicare's outlier payment adjustment for home health care influenced treatment intensity and discharge status for home health patients.
Effects of the ten percent cap in Medicare Home Health care on treatment intensity and patient discharge status
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
Models that better match costs modestly decrease this risk, and the retrospective payment model and the outlier payment policies reduce risk most
A Clinically Detailed Risk Information System for Cost
[(Standard Base Amount).sub.Geographic_Adjusted] * [DRG.sub.WEIGHT] + (Outlier Payment) + Passthru + IME + DSH (4)
Estimation of standardized hospital costs from Medicare claims that reflect resource requirements for care: impact for cohort studies linked to Medicare claims
The analogous high-cost outlier payment is a fraction of costs after the case passes a threshold.
Use of diagnosis-related groups by non-Medicare payers
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