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Elizabeth M. Whitehorn, Director

Provider Notice issued 10/11/11

Addendum to July 25, 2011, Notice to Hospitals Adjustments Related to Cost Outlier Payment Calculation Change

​To: Participating Hospitals: Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers​
​Date: ​October 11, 2011
​Re: Addendum to July 25, 2011, Notice to Hospitals Adjustments Related to Cost Outlier Payment Calculation Change​

The department is initiating adjustments pursuant to the cost outlier payment calculation change identified in the July 25, 2011 notice to hospitals.

For those hospital claim adjustments that will result in recovery of monies, the department will off-set future claims as a means to recover the overpayments, but the off-set will be limited to no more than fifty percent (50%) of the value of any single Remittance Advice. By doing this, the department will ensure hospitals continue to receive some level of payment until the balance is recovered.

All adjustments will appear as usual on your remittances advices, with the adjustment reason code 3551 - Outlier Adj Re-pricing Pursuant to P.A. 97-0074.

Any questions regarding this update may be directed to the Bureau of Rate Development and Analysis at 217-785-0710, Hospital Reimbursement Section.