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CMS’ Proposed Outlier Payment Threshold Too High Again, Hospitals Warn

This article was originally published in The Gray Sheet

Executive Summary

The proposed $35,085 threshold for hospital inpatient cases to qualify for FY 2005 Medicare outlier payments should be lowered to $27,000 or less, the American Hospital Association argues

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Implantable defibrillator payments: CMS appears to be waiting to determine ICD payments until it issues a decision expanding national coverage based on the SCD-HeFT trial population, expected by year-end. The agency came under heavy fire from industry and professional societies for soliciting comments in the inpatient prospective payment system proposed rule on ways to encourage less expensive use of ICDs when clinically appropriate (1"The Gray Sheet" July 5, 2004, p. 8). The final rule does not discuss stakeholder comments or a final policy...

FY 2005 Medicare Inpatient Payment Rule In Brief

Implantable defibrillator payments: CMS appears to be waiting to determine ICD payments until it issues a decision expanding national coverage based on the SCD-HeFT trial population, expected by year-end. The agency came under heavy fire from industry and professional societies for soliciting comments in the inpatient prospective payment system proposed rule on ways to encourage less expensive use of ICDs when clinically appropriate (1"The Gray Sheet" July 5, 2004, p. 8). The final rule does not discuss stakeholder comments or a final policy...

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