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IPPS outlier payments

This article was originally published in The Gray Sheet

Executive Summary

CMS directs fiscal intermediaries to schedule all comprehensive field audits and complete all medical reviews by July 31 for hospitals generating an unusually high level of Medicare payments through the hospital inpatient prospective payment system's outlier pool. The agency announced Dec. 3, 2002 criteria for FIs to identify hospitals that may be "gaming" IPPS to boost outlier payments (1"The Gray Sheet" Dec. 9, 2002, p. 13)...
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