Submitting OIG:
Report Description:
Outlier claim payments are based on hospital cost reports from the latest cost-reporting period for which the cost report is either settled as final or tentatively settled. The Centers for Medicare & Medicaid Services (CMS) requires its Medicare administrative contractors to reconcile outlier payments by using information from the updated current cost-reporting period, but only if the cost report meets the following criteria: the actual cost-to-charge ratio (CCR) is found to be plus or minus 10 percentage points from the CCR applied during the payment period (10-percentage-point threshold), and the outlier payments in that cost reporting period exceed $500,000.
Date Issued:
Friday, November 22, 2019
Agency Reviewed / Investigated:
Submitting OIG-Specific Report Number:
A-05-16-00060
Component, if applicable:
Centers for Medicare & Medicaid Services
Location(s):
Agency-Wide
Type of Report:
Audit
Questioned Costs:
$0
Funds for Better Use:
$125,000,000
Number of Recommendations:
1
View Document:
Attachment | Size |
---|---|
51600060 Hospitals Receive Millions.pdf | 13.89 KB |
Additional Details Link: