Article Detail - JE Part A

CMS issued Change Request 13566 earlier this year, which introduces new criteria for reconciling outlier payments for hospitals under the IPPS and LTCH PPS. Effective October 1, 2024, MACs must refer cost reports to the CMS Central Office for approval if the actual operating CCR deviates by 20% or more from the CCR used for outlier payments, and if total outlier payments exceed $500,000. Upon approval, MACs will follow specific Medicare Claims Processing Manual instructions to reconcile these payments.

View the complete CMS Change Request (CR) 13566.