Medicare Hospital Outlier Payments Warrant Increased Scrutiny

HHS: 11-13-2013

WHY WE DID THIS STUDY

Medicare makes supplemental payments to hospitals, known as outlier payments, which are designed to protect hospitals from significant financial losses resulting from patient-care cases that are extraordinarily costly. Unlike predetermined payment amounts for most Medicare hospital claims, outlier payments are directly influenced by hospital charges. Responding to problems caused by some hospitals aggressively increasing charges, CMS made policy changes in 2003 to ensure the accuracy of outlier payments. This report describes a more recent distribution of such payments. Read More