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Home Health & Hospice Week

Reimbursement:

Outlier Revamp Aims To Fight Fraud

Published on Tue Jul 07, 2009

Per-agency outlier payments to be capped at 10 percent under latest proposal. Asurprising policy shift about HHA outliers is meeting with approval from the industry. The Centers for Medicare & Medicaid Services began seeing a rapid increase in outlier payments for high-visit patients in the last few years,it says in the proposed rule for the 2010 prospective payment system update. "We noticed statistical anomalies in outlier payments in terms of both high outlier dollars and as a percentage of total HH PPS payments, in areas such as Miami-Dade Florida," CMS says in the rule published in the Aug. 6 Federal Register. "Outlier payments to providers far exceed the national average and the 5 percent target for outlier payments" in these areas, CMS notes. Other outlier hot spots are in Texas and California, the agency notes. Background: CMS started out with a fixed dollar loss (FDL) ratio of 1.13 when PPS [...]
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