Cost outlier definition

Cost outlier means cases which have an extraordinarily high cost as established in 79.1(5)“f,” so as to be eligible for additional payments above and beyond the initial DRG payment.

Cost outlier means services provided during a single visit that have an extraordinarily high cost as established in paragraph “g” and are therefore eligible for additional payments above and beyond the base APC payment.

Cost outlier means cases which have an extraordinarily high cost as established in paragraph

Examples of Cost outlier in a sentence

• Cost outlier payments shall be paid on short stay outlier cases that qualify as a cost outlier.

• Cost outlier status does not depend on length of stay as such, but in practice cost outlier stays tend to be long stays—hence the requirement for concurrent review on stays that exceed 19 days.

• Cost outlier payments may be subject to adjustment in cases of suspected fraud and/or abuse.

• Cost outlier payments will be made to stays that qualify as a cost outlier stay, which will be determined by comparing the hospital’s estimated loss on a particular stay with the cost outlier threshold amount.

• Cost- outlier payments could be made in 1991-1994 whenever the hospital’s cost-adjusted charges exceeded a fixed multiple of the applicable DRG prospective payment rate or a fixed dollar amount determined by the Secretary, whichever was greater.

• Cost outlier status is reached on the day that charges reach the cost outlier status for the applicable DRG for inpatient PPS or CMS in the case of IRF PPS.

• Cost outlier" means an additional payment for unusually high cost cases that exceeds the cost outlier thresholds as set forth in ARM 37.86.2916.

• Cost outlier proposals removed from normalization will automatically receive the maximum (if their cost was abnormally below the mean) or minimum (if their cost was abnormally above the mean) points for cost.

• Cost outlier stays are stays that exceed the cost outlier threshold for the DRG.

More Definitions of Cost outlier

Cost outlier means cases which have an extraordinarily high cost as established in 79.1(5)“f,” so as to be eligible for additional payments above and beyond the initial DRG payment. “Critical access hospital” or “CAH” means a hospital licensed as a critical access hospital by the

Cost outlier means cases which have an extraordinarily high cost as established in 79.1(5)“f,” so as to be eligible for additional payments above and beyond the initial DRG payment. “Diagnosis-related group (DRG)” shall mean a group of similar diagnoses combined based on pa-

Cost outlier means cases which services provided during a single visit that have an extraordinarily high cost as established in paragraph “g” and, thus, are therefore eligible for additional payments above and beyond the base APG APC payment.

Cost outlier means an additional payment for unusually high cost cases that exceeds the cost outlier thresholds as set forth in ARM 37.86.2916.