What is outlier payment

Accountable Care. Acute Care. Kaiser, Mayo, Medically Home promote advanced hospital-at-home services. Ambulatory Care. Business Intelligence. Anthem to acquire Integra Managed Care. Practices keeping close watch on risk adjustment coding. Meaningful Use. CMS overhauls meaningful use as 'Promoting Interoperability'. Patient Engagement.

Amazon to launch Alexa at senior living facilities, health systems. People who spread vaccine misinformation are 'criminals' says Pfizer CEO. Population Health. Risk Management.

Senate bill would make telehealth reimbursement permanent for certain services. Attorneys general move to block New Jersey hospital merger. Payers must change dynamic with providers to survive in the post-Affordable Care Act world. EHRs can include controlled substance histories via Appriss Health. Events Newsletters Sponsored About. Top Stories. Eleven states file lawsuit over vaccine mandate.

As part of the prospective payment system, the government pays 'outlier' payments for especially long or expensive cases. These payments can be viewed as insurance for the hospital against excessive losses. They mitigate problems of access and underprovision of care for the sickest patients, and provide additional payments to the hospitals that take care of them, thereby making payments to hospitals more equitable. Photo Credit. Medicare normally reimburses hospitals for patient care according to the appropriate Diagnostic Related Groups.

The government pays a flat fee for patient care rather than an itemized bill. The government set up this system to put the impetus on the hospital to find cost efficient ways to treat patients.

However, the government does not want to bankrupt hospitals that engage in costly treatments to save patients. To address this problem, Medicare will also make supplemental payments for cases that involve costs over a set threshold. These additional payouts are known as outlier payments. Nearly all hospitals receive them. A hospital indicates its interest in receiving an additional payment for patient treatment in the initial submission of its UB form.

In , the Office of the Inspector General determined that outlier payments warrant increased scrutiny.