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amount ($10,000) and the outlier payment amount ($29,540). IPPS Outlier Payment Policy Changes In the 2003 IPPS Final Rule, CMS made changes to its outlier payment
(3) The hospital stay shall qualify as a day outlier under the criteria in subsection (b) based on the medically necessary days certified by the Department. (d) The Department will determine the outlier payment amount for a day outlier by: (1) Determining a per diem amount for the DRG by dividing the hospitalâs payment amount for the DRG by the Statewide average length of stay for the DRG.