Grimaldi P L
Hosp Prog. 1984 Mar;65(3):42-3, 60.
The final rules for the first year of Medicare's prospective payment contain a number of crucial revisions of the interim rules: Payment standards. Because of a revised estimate of inflation, the adjusted federal standardized payment amounts have been reduced about $12. Update factors. Revised inflation updating factors will be applied to the hospital-specific portion of payment rates and will reflect a lower (0.1 percent) budget-neutrality adjustment. Outliers. For the three-year transitional period, additional payments for outlier patients will be based entirely on a smaller percentage of the federal payment amounts. Permissible charges to beneficiaries. Hospitals may charge beneficiaries for custodial care and medically unnecessary services before the day-outlier threshold is passed if the hospital or its utilization review committee determines that the beneficiary no longer needs inpatient care; this determination is confirmed by the attending physician or external medical review entity; and the patient is notified of the determination and potential charges. Periodic interim payment. This payment may be adjusted semiannually, or more frequently at a hospital's request. Biweekly payments will be made for items reimbursed on a reasonable-cost basis.
支付标准。由于对通货膨胀的估计有所修订，调整后的联邦标准化支付金额减少了约12美元。更新因素。修订后的通货膨胀更新因素将应用于支付费率中特定医院部分，并将反映较低的（0.1%）预算中性调整。异常值。在三年过渡期内，对异常值患者的额外支付将完全基于联邦支付金额的较小百分比。向受益人收取的允许费用。如果医院或其利用审查委员会确定受益人不再需要住院治疗，且主治医生或外部医疗审查实体确认该决定，并且已将该决定和潜在费用通知患者，则医院可在达到日间异常值阈值之前向受益人收取监护护理和医疗不必要服务的费用。定期中期支付。此支付可每半年调整一次，或应医院要求更频繁地调整。对于按合理成本报销的项目，将每两周支付一次。
