Outlier Threshold definition

Outlier Threshold means the Medicare outlier threshold used in determining high cost outlier payments.
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Outlier Threshold means a dollar amount by which the total billed charges on the claim must exceed the MS-DRG Allowable Fee in order to qualify for an additional Outlier amount.
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Outlier Threshold means the level of estimated cost for a claim that when exceeded for an inpatient stay triggers an outlier payment in addition to the DRG base payment;
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Examples of Outlier Threshold in a sentence

  • If a Hospital qualifies for an Outlier Payment, the Outlier Payment will equal the product of the Marginal Cost Factor and the amount by which the Discharge-Specific Case Cost exceeds the Discharge-Specific Outlier Threshold.

  • If the Episode-Specific Case Cost exceeds the Episode-Specific Outlier Threshold, then an APEC Outlier Component is computed equal to the Marginal Cost Factor set at 60%, multiplied by the difference between the computed Episode-Specific Case Cost and the Episode-Specific Outlier Threshold.

  • The patient is not a patient in an Excluded Unit within an Acute Hospital.If a Hospital qualifies for an Outlier Payment, the Outlier Payment will equal the product of the Marginal Cost Factor and the amount by which the Discharge-Specific Case Cost exceeds the Discharge-Specific Outlier Threshold.

  • EGID shall review the Base Rate Marginal Cost Factor, Outlier Threshold and Certification procedure list, notifying the Facility of changes by a general mailing sixty (60) days prior to implementation.

  • Episode-Specific Outlier Threshold – The sum of (1) the Episode-Specific Total EAPG Payment, as determined by EOHHS, and (2) the Fixed Outpatient Outlier Threshold.

  • If the Episode-Specific Case Cost does not exceed the Episode-Specific Outlier Threshold, then the APEC Outlier Component is $0.In no case is an APEC Outlier Component payable if the Episode-Specific Total EAPG Payment is $0.

  • The Hospital’s Discharge-Specific Case Cost exceeds the Discharge-Specific Outlier Threshold for that discharge; b.

  • Fixed Outpatient Outlier Threshold – For RY17, the Fixed Outpatient Outlier Threshold for purposes of calculating the APEC Outlier Component is $2,100.

  • Geometric Mean 5 ÷ 10 = 0.5 Cost Outlier Threshold = (A + B) x C ($6,688.08 + $8,590.26) x 0.5 = $7,639.17 NOTE: If the LOS exceeds the geometric mean LOS, the outlier threshold shall be limited to the DRG base payment plus the fixed loss threshold (wage- adjusted).

  • The cost of a claim is estimated by multiplying the hospital’s Ratio of Cost to Charges (RCC) by the billed charges.b) Outlier Threshold Factor.


More Definitions of Outlier Threshold

Outlier Threshold means a dollar amount published by CMS by which the total billed charges on the claim must exceed the MS-LTC-DRG Allowable Fee in order to qualify for an outlier allowable fee.
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Outlier Threshold means the Medicare outlier threshold used in determining high cost out- lier payments.
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Outlier Threshold means a dollar amount by which the total billed charges on the claim must exceed the MS-DRG Allowable Fee in order to qualify for an additional Outlier amount.‌
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Related to Outlier Threshold

  • Minimum Threshold means the average daily yield on the 10 Year Treasury Note (as reported in the Bloomberg GT10 index) over the Award Period.

  • Bid threshold means the dollar amount set in N.J.S.A. 18A:18A-3, above which a Board shall advertise for and receive sealed bids in accordance with procedures set forth in N.J.S.A. 18A:18A-1 et seq.

  • Threshold means with respect to Party B: infinity.

  • Restoration Threshold means an amount equal to 5% of the outstanding principal amount of the Loan.

  • Simplified acquisition threshold means the dollar amount below which a district may purchase property or services using small pur- chase methods. Districts adopt small purchase procedures in order to expedite the purchase of items at or below the simplified acquisi- tion threshold. The simplified acquisition threshold for procurement activities administered under federal awards is set by the FAR at 48 C.F.R. Part 2, Subpart 2.1 [see below]. The district is responsi- ble for determining an appropriate simplified acquisition threshold based on internal controls, an evaluation of risk, and its docu- mented procurement procedures. However, in no circumstances can this threshold exceed the dollar value established in the FAR

  • stipulated minimum threshold means that portion of local production and content as determined by the Department of Trade and Industry; and

  • Covered Debt Amount means, on any date, the sum of (x) all of the Revolving Credit Exposures of all Lenders on such date plus (y) the aggregate principal amount (including any increase in the aggregate principal amount resulting from payable-in-kind interest) of Other Covered Indebtedness outstanding on such date.