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Department of Health
& Human Services: Centers for Medicaid and Medicare
42 CFR Part 412
 Medicare Program: Change in Methodology for
Determining Payment for Extraordinary High-Cost Cases (Cost
Outliers) Under Acute Care Hospital Inpatient and Long-Term Care
Hospital Prospective Payment Systems; Final Rule
In the final rule, HHS and CMS 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 patient system (IPPS). They
are also 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 (LTCH) under the
long-term hospital prospective payment system (LTCH PPS).
the policies for determining the outlier payment under LTCH PPS
are modeled after the outlier payment policies under the IPPS.
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