How is the annual outlier limit applied and figured?
The outlier policy has changed so that HHAs may not receive outlier payments which exceed 10% of their total HH PPS payments in a calendar year. When an outlier payment is calculated for an episode, the system looks at the total HH PPS payments received by the HHA during the calendar year and compares it to the available pool for outlier payments. If the amount payable exceeds the outlier amount available, the claim is processed with the episode payment only. The system adds a code to the claim that indicates an outlier amount was calculated for the episode, but was unable to be paid. If the outlier amount payable does not exceed the available outlier pool amount, the outlier amount is paid with the claim at the time it processes.
