CMS did not propose any changes to the Outlier Provision for 2015.  I believe that this is the first time in several years that no changes have been proposed by CMS to this provision.  However, that does not impact my following comment in regards to the Outlier Provision in general; which is as follows:

The Outlier Provision should be eliminated in its entirety. This has been very problematic since its inception for both the industry and the FI/MACs and has deprived the industry of Billions of dollars over the years.  This provision provides little benefit to the industry and the costs of this program to the industry far-and-away outweigh any benefits derived.  Additionally, you have noted in the past and in this proposed rule the incidents of what appear to be fraudulent and/or abusive activities surrounding this provision; and even with the horrendous 10% cap (not in theory, just in application) have not really ever been controlled.  Additionally, I have never heard that there has ever been any extensive on-site reviews of these ‘potentially problematic’ providers in those limited geographic areas; so just eliminate this provision and these issues are no-longer issues going forward.


Look at other blog entries as to the problems that I feel are greater in nature than the benefits this provision provides for the home health industry in general.