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IPPS “outlier” system

This article was originally published in The Gray Sheet

Executive Summary

Proposed rule set to be published by CMS in the March 5 Federal Register attempts to crack-down on hospitals taking advantage of the outlier portion of the hospital inpatient prospective payment system. The outlier system is intended to partly reimburse hospitals when costs greatly exceed the reimbursement rate. The proposed rule would allow CMS to recover overpayments if the actual costs of a case denoted in the cost report are less than the provider had claimed. The agency recently began targeting hospitals deemed to be "gaming" the system (1"The Gray Sheet" Dec. 9, 2002, p. 13). Comments on the proposal are due April 4. A final rule will be issued "as soon as possible," according to CMS...

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