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Home Health & Hospice Week

Fraud & Abuse:

Outliers On Track For Decrease

Published on Wed Jun 15, 2011

Don't overlook the PPS rule's smaller provisions. The reimbursement cuts due to case mix creep may be making all the headlines, but there are other important provisions in the newly proposed 2012 prospective payment system rule published in the July 12 Federal Register. Take note of these PPS proposed rule items: Outliers. The Centers for Medicare & Medicaid Services' 10 percent cap on outlier payments that began last year seems to be doing the trick to reduce overuse of the payments. By midthird quarter of 2010, CMS had paid 1.68 percent of HHA payments in outliers. That compares to percentage exceeding 6 percent in the previous three years, CMS says in the proposed rule. The agency aims to pay out 2.5 percent in outliers annually. Despite that success, CMS proposes to leave outlier calculations the same, including the fixed dollar loss ratio of 0.67 percent. "However, in the final rule, [...]
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