Payment Outliers

On Friday February 28, 2003, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule on payments for extremely high-cost (outlier) cases.  The regulation could affect every hospital, because CMS' proposal eliminates use of the statewide average cost-to-charge ratio for certain hospitals, reconciles outlier payments through final settlement of the Medicare cost report for all hospitals, and maintains the outlier threshold at its current level, which should have been lowered as a result of the above changes, but now would prevent most hospitals from qualifying for outlier payments.  Comments were due April 4. The AHA prepared the attached advocacy material to address the issue: an AHA comment letter, a sample letter you can tailor, and an AHA Member Advisory detailing the proposed rule.

Advocacy Resources

03/25/2003  AHA Regulatory Advisory: Proposed Changes to Medicare Inpatient PPS: Outlier Payments

03/31/2003  Outlier Sample Comment Letter

03/31/2003  AHA Outlier Comment Letter

04/14/2003  AHA News Now Advocacy Alert: Outliers – It’s Time for Congress to Weigh, In 

05/08/2003  Letter to HHS and CMS regarding application of the Congressional Review Act to outliers

07/02/2003  Comment letter regarding changes to the Hospital Inpatient Prospective Payment System and Fiscal 2004 Rates



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