United States Government Publishing Office publisher pbl distributor dst United States National Archives and Records Administration Office of the Federal Register author aut Government Organization text government publication eng FR Regulatory Information 2003_register executive 2010-09-23 article Part II Rules and Regulations D09002ee1c817b93c D09002ee1c817ba27 United States Department of Health and Human Services originator org United States Government Agency or Subagency United States Centers for Medicare & Medicaid Services originator org United States Government Agency or Subagency In this final rule, we are revising the methodology for determining payments for extraordinarily high-cost cases (cost outliers) made to Medicare-participating hospitals under the acute care hospital inpatient prospective payment system (IPPS). Under the existing outlier methodology, the cost-to-charge ratios from hospitals' latest settled cost reports are used in determining a fixed-loss amount cost outlier threshold. We have become aware that, in some cases, hospitals' recent rate-of-charge increases greatly exceed their rate-of-cost increases. Because there is a time lag between the cost-to-charge ratios from the latest settled cost report and current charges, this disparity in the rate-of-increases for charges and costs results in cost-to-charge ratios that are too high, which in turn results in an overestimation of hospitals' current costs per case. Therefore, we are revising our outlier payment methodology to ensure that outlier payments are made only for truly expensive cases. We also are revising the methodology used to determine payment for high-cost outlier and short-stay outlier cases that are made to Medicare-participating long-term care hospitals (LTCHs) under the long- term care hospital prospective payment system (LTCH PPS). The policies for determining outlier payment under the LTCH PPS are modeled after the outlier payment policies under the IPPS. 68 FR 34494 https://www.govinfo.gov/app/details/FR-2003-06-09/03-14492 03-14492 fr09jn03-20 RIN 0938-AM41 4120-01-P CMS-1243-F https://www.govinfo.gov/app/details/FR-2003-06-09/03-14492 https://www.govinfo.gov/content/pkg/FR-2003-06-09/html/03-14492.htm https://www.govinfo.gov/content/pkg/FR-2003-06-09/pdf/03-14492.pdf Administrative Practice and Procedure Health Facilities Medicare Puerto Rico Reporting and Recordkeeping Requirements 22 p. 34494 34515 68 FR 34494 Title 42 Part 412 42 CFR Part 412 RIN 0938-AM41 Medicare Program; Change in Methodology for Determining Payment for Extraordinarily High-Cost Cases (Cost Outliers) Under the Acute Care Hospital Inpatient and Long-Term Care Hospital Prospective Payment Systems; Federal Register Vol. 68, Issue RULE 03-14492 II DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 2003-08-08 CMS-1243-F 4120-01-P 03-14492 Final rule.

In this final rule, we are revising the methodology for determining payments for extraordinarily high-cost cases (cost outliers) made to Medicare-participating hospitals under the acute care hospital inpatient prospective payment system (IPPS). Under the existing outlier methodology, the cost-to-charge ratios from hospitals' latest settled cost reports are used in determining a fixed-loss amount cost outlier threshold. We have become aware that, in some cases, hospitals' recent rate-of-charge increases greatly exceed their rate-of-cost increases. Because there is a time lag between the cost-to-charge ratios from the latest settled cost report and current charges, this disparity in the rate-of-increases for charges and costs results in cost-to-charge ratios that are too high, which in turn results in an overestimation of hospitals' current costs per case. Therefore, we are revising our outlier payment methodology to ensure that outlier payments are made only for truly expensive cases. We also are revising the methodology used to determine payment for high-cost outlier and short-stay outlier cases that are made to Medicare-participating long-term care hospitals (LTCHs) under the long- term care hospital prospective payment system (LTCH PPS). The policies for determining outlier payment under the LTCH PPS are modeled after the outlier payment policies under the IPPS.

The provisions of this final rule are effective on August 8, 2003. Stephen Phillips, (410) 786-4548 (IPPS Outlier Policy) Miechal Lefkowitz, (410) 786-5316 (LTCH PPS Outlier Policy) Administrative Practice and Procedure Health Facilities Medicare Puerto Rico Reporting and Recordkeeping Requirements Medicare and medicaid: Acute care hospital inpatient and long-term care hospital prospective payment systems, baguilar@omb.eop.gov http://www.access.gpo.gov/nara/index.html Vol. 68, no. 110 Office of the Federal Register, National Archives and Records Administration 2003-06-09 continuing daily deposited born digital 270 p. Table of Contents: AE 2.7: GS 4.107: AE 2.106: KF70.A2 https://www.govinfo.gov/app/details/FR-2003-06-09 P0b002ee1809b59fd 0097-6326 0042-1219 0364-1406 769-004-00000-9 000582072 f:fr09jn03 https://www.govinfo.gov/app/details/FR-2003-06-09 https://www.govinfo.gov/content/pkg/FR-2003-06-09/pdf/FR-2003-06-09.pdf https://www.govinfo.gov/content/pkg/FR-2003-06-09/xml/FR-2003-06-09.xml fdlp 34261 34515 DGPO 2010-09-23 2024-06-07 FR-2003-06-09 machine generated eng FR FR-2003-06-09 68 110