Outlier payments

For CY 2014, CMS proposes that hospital outlier payments would be triggered when the cost of furnishing a service or procedure by a hospital exceeds both the multiple threshold of 1.75 times the APC payment amount and the $2,775 fixed-dollar threshold over the APC payment rate. Outlier payments would be equal to 50 percent of the amount by which the cost of furnishing the service exceeds 1.75 times the APC payment amount, when both the multiple threshold and the fixed-dollar threshold are met. CMS estimates that outlier payments for CY 2014 would equal 1.0 percent of total OPPS payments. CMS currently estimates that aggregate outlier payments for CY 2013 will be approximately 1.2 percent of the total CY 2013 OPPS payments.