The CCRs are also used in determining outpatient hospital outlier payments, payments for passthrough devices and monthly interim transitional corridor payments under the outpatient prospective payment system (OPPS). The CCRs for OPPS will be addressed in a separate Program Memorandum (PM).
To determine whether a case qualifies for outlier payments under the hospital inpatient prospective payment system (IPPS), hospital-specific cost-to-charge ratios are applied to the total covered charges for the case. Operating and capital costs for the case are calculated separately by applying separate operating and capital cost-to-charge ratios and combining these costs to compare them with the fixed-loss outlier threshold. There are also States with national average IPPS total CCRs, which were discussed in section V.D.2. of the Addendum.