Provider Preventable Condition. A Hospital acquired condition or a condition occurring in any health care setting that has been found by the state, based upon a review of medical literature by qualified professionals, to be reasonably preventable through the application of procedures supported by evidence-based guidelines, has a negative consequence for the beneficiary, and is auditable.
Provider Preventable Condition. A hospital acquired condition or a condition occurring in any health care setting that has been found by the State, based upon a review of medical literature by qualified professionals, to be reasonably preventable through the application of procedures supported by evidence-based guidelines, has a negative consequence for the Enrollee, and is auditable. Quality Assurance Supplement (QAS) - Supplemental payment made to nursing facilities that incorporates funds from the quality assurance assessment tax as approved in the Michigan state plan. Quality Improvement Organization (QIO) – As set forth in Section 1152 of the Social Security Act and 42 C.F.R. Part 476, an organization under contract with CMS to perform utilization and quality control peer review in the Medicare program or an organization designated as QIO-like by CMS. The QIO or QIO-like entity provides quality assurance and utilization review. Rapid Dispute Resolution Process - The process implemented by MDHHS to administer and resolve Claim disputes.
Provider Preventable Condition. A condition that (1) meets the requirements of an “Other Provider Preventable Condition” pursuant to 42 C.F.R. 447.26(b); and/or (2)a hospital acquired condition or a condition occurring in any health care setting that has been found by the state, based upon a review of medical literature by qualified professionals, to be reasonably preventable through the application of procedures supported by evidence-based guidelines, has a negative consequence for the beneficiary, and is auditable. DMAS’ policy regarding Provider Preventable Conditions is set out in 12 VAC 00-00-000 and 12 VAC 00-00-000.
Provider Preventable Condition. Health care-acquired condition means a condition occurring in a hospital setting, identified as HAC in the State Plan as described in Section 1886(d)(4)(D)(ii) and (iv) of the Social Security Act; other than Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE) as related to total knee replacement or hip replacement surgery in pediatric and obstetric patients. Other provider-preventable condition means a condition occurring in any health care setting that meets the following criteria: (1) is identified in the State plan (2) has been found by the State, based upon a review of medical literature by qualified professionals, to be reasonably preventable through the application of procedures supported by evidence-based guidelines, (3) has a negative consequence for the beneficiary, (4) is auditable, and (5) includes, at a minimum, wrong surgical or other invasive procedure performed on a patient; surgical or other invasive procedure performed on the wrong body part; surgical or other invasive procedure performed on the wrong patient.
Provider Preventable Condition. Preventable healthcare-acquired or other provider-preventable conditions and events, also known as never events, identified by LDH for nonpayment, including but not limited to, conditions such as bed pressure ulcers or decubitus ulcers; events such as surgical or invasive procedures performed on the wrong body part or wrong patient; or wrong surgical procedure performed on a patient.
