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42 CFR 412.86 : Public Health (Part 1 To Parts 1009-1099) — (Subpart A To § 413.355) — Centers For Medicare & Medicaid Services, Department Of Health And Human Services (Subpart A To § 413.355) — Medicare Program (Subpart A To § 413.355) — Prospective Payment Systems For Inpatient Hospital Services (§ 412.1 To § 412.634) — Payments For Outlier Cases, Special Treatment Payment For New Technology, And Payment Adjustment For Certain Replaced Devices (§ 412.80 To § 412.89) — Payment For Outlier Cases (§ 412.80 To § 412.86) — Payment for extraordinarily high-cost day outliers.

4 Aug 2016

For discharges occurring before October 1, 1997, if a discharge that qualifies for an additional payment under the provisions of § 412.82 has charges adjusted to costs that exceed the cost outlier threshold criteria for an extraordinarily high-cost case as set forth in § 412.80(a)(1)(ii), the additional payment made for the discharge is the greater of -

(a) The applicable per diem payment computed under § 412.82 (c) or (d); or

(b) The payment that would be made under § 412.84 (i) or (j) if the case had not met the day outlier criteria threshold set forth in § 412.80(a)(1)(i).

42 CFR 412.86
[53 FR 38529, Sept. 30, 1988, as amended at 62 FR 46028, Aug. 29, 1997]