Change in Methodolgy for Determining Payment for Outliers
Under the existing IRF PPS outlier methodology, the
CCR from an IRF’s latest settled cost report is used in determining whether a case
qualifies for payment as an outlier and the amount of any such payment. Based on the
final rule published in the Federal Register on August 1, 2003, this CR provides
instructions for applying CCRs for IRFs, including: the use of an alternative CCR when
directed by CMS or at the request of the facility and the use of a CCR based on the
tentative settlement of the cost report for discharges on or after October 1, 2003; use of
the national averages; the criteria for identifying hospitals to be subject to reconciliation;
and notification to hospitals about those updates.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: February 06, 2004
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