Payment Group definition
Examples of Payment Group in a sentence
OSEEGIB shall categorize what shall constitute a covered procedure and an ASC Payment Group.
If Group disagrees with a determination of an Improper Payment, Group must submit, within thirty (30) days after receipt of notification, a written explanation along with all supporting documents.
In the event Group receives an Improper Payment, Group shall promptly notify HCT of the Improper Payment in writing.
An ASC may request a review of a billing code for inclusion in an ASC Payment Group by addressing a written request with supporting documentation to: OSEEGIB, Provider Relations, ▇▇▇▇ ▇▇ ▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇▇ ▇▇▇, ▇▇▇▇▇▇▇▇ ▇▇▇▇, ▇▇▇▇▇▇▇▇ ▇▇▇▇▇.
The CPT/HCPCS and the appropriate ASC Payment Group to which each is assigned is incorporated in this contract by reference, labeled as Exhibit A.
If more than one surgical procedure is performed in the same operative session, the procedure in the more comprehensive ASC Payment Group will receive full payment and the remaining procedure(s) will be allowed at fifty percent (50%) of the reimbursement rate for the next covered ASC Payment Group.
As soon as reasonably possible after receiving data regarding the Amount Allegedly Withheld from each Claimant’s AdSense account, the Settlement Administrator will provide Class Counsel and Defendant’s Counsel the total number of Claimants in each Payment Group, the total Amount Allegedly Withheld for each Payment Group, and its best estimate of the Adjusted Amount for each Payment Group.
To illustrate, if the total of the Adjusted Amounts for all Valid Claims were twice the Net Settlement Fund, Claimants in Payment Group 1 would receive 50% of their Amounts Allegedly Withheld, Claimants in Payment Group 2 would receive 25% of their Amounts Allegedly Withheld, and Claimants in Payment Group 3 would receive 15% of their Amounts Allegedly Withheld.
Next, the Settlement Administrator shall repeat Step Two above, this time excluding the Total Balances for the No Payment Group, to arrive at the Final Entitlement Percentage for each remaining Class Member (i.e., Final Entitlement Percentage = [positive Total Balance for each Class Member not in the No Payment Group] ÷ [Total Balance For The Class minus the Total Balance for the No Payment Group]).
If more than one procedure in the same ASC Payment Group is performed, one procedure will be reimbursed the full payment and the remaining procedure(s) will be reimbursed at fifty percent (50%) of the reimbursement rate.