Outlier Threshold definition
Outlier Threshold means the Medicare outlier threshold used in determining high cost outlier payments.
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.
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;
Examples of Outlier Threshold in a sentence
The following formula shall be utilized to calculate the Outlier Allowable Fee: Outlier Allowable Fee = [billed charges – (MS-DRG Allowable Fee + Outlier Threshold)] x Marginal 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.
Outlier Threshold means the Medicare outlier threshold used in determining high cost out- lier payments.
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.