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What is Medicare?s definition of an ?outlier payment??

Homecare Insider Q&A, October 21, 2010

The definition of an outlier payment is “an addition or adjustment in the 60-day episode payment due to unusual variation in the type or amount of medically necessary home health care.” The outlier payment is determined by a complex computation, based on risk sharing and revenue loss for the agency, taking into account only the cost of visits, not supplies. An agency can receive an outlier payment, which will only partially offset the financial burden of caring for expensive patients. The fixed dollar loss for 2010 is 0.67. To address the continuing problems with excessive outlier payments in South Florida, CMS will cap outlier payments to an agency at 10 percent of its total payments, and reduce outlier payments to 2.5 percent of all home health PPS payments.

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