Prospective Payment System definition
Prospective Payment System and “PPS” each means the payment methodology described in 42 USC 1396a(bb) that is applicable to Federally Qualified Health Centers and Rural Health Centers.
Prospective Payment System. (PPS) means a method of reimbursement in which payment is made based on a predetermined, fixed amount. The payment amount for a particular service is derived based on the classification system of that service – for example, diagnosis-related groups for inpatient hospital services. Provider means an institution, facility, agency, physician, health care practitioner, or other entity that is licensed or otherwise authorized to provide any of the Covered Services in the state in which they are furnished. Providers include individuals and vendors providing services to Members through the Self-Directed Community Benefit.
Prospective Payment System. (PPS) means a method of reimbursement in which payment is made based on a predetermined, fixed amount. The payment amount for a particular service is Provider means an institution, facility, agency, physician, health care practitioner, or other entity that is licensed or otherwise authorized to provide any of the Covered Services in the state in which they are furnished. Providers include individuals and vendors providing services to Members through the Self-Directed Community Benefit. Provider Preventable Conditions (PPC) means a condition that meets the definition of Health Care Acquired Conditions (HCAC) or Other Provider Preventable Conditions. Provider Satisfaction Survey shall have the meaning ascribed to such term in Section 4.12.6 of this Agreement.
Examples of Prospective Payment System in a sentence
However, this payment will be limited so that the total payment received by the Provider for a service, including payment from all sources, does not exceed the Prospective Payment System (PPS) utilizing Diagnosis Related Groupings (DRG) reimbursement for that service.
The methadone per diem rate for OTPs will be updated annually by the Medicare update factor used for their Inpatient Prospective Payment System (IPPS).
For acute care hospitals that qualify as a “Rural Provider” under the North Carolina State Health Plan Pricing Policy, outpatient services identified by CMS Outpatient Prospective Payment System (OPPS) Status codes will be priced based on 235% of the then current Medicare APC allowable rates, geographically adjusted.
For professional services billed on a CMS-1500 or successor form, 160%, and for technical services billed on a UB-04 form, 200% of current rate under the Medicare FQHC Prospective Payment System.
Average Patient Visits Per Half Day (APVPHD) is determined by the number of billable face-to-face (including billable telemedicine at the full Prospective Payment System (PPS) rate) patient encounters per one half day of scheduled patient care time in primary care.
More Definitions of Prospective Payment System
Prospective Payment System means a system of classifying episodes of care for billing and reimbursement pur- poses, based on factors such as diagnoses, age, and sex.
Prospective Payment System. (PPS) means a method of reimbursement in which payment is made based on a predetermined, fixed amount. The payment amount for a particular service is derived based on the classification system of that service – for example, diagnosis-related groups for inpatient hospital services. Provider means an institution, facility, agency, physician, health care practitioner, or other entity that is licensed or otherwise authorized to provide any of the Covered Services in the state in which they are furnished. Providers include individuals and vendors providing services to Members through the Self-Directed Community Benefit. Provider Preventable Conditions (PPC) means a condition that meets the definition of Health Care Acquired Conditions or Other Provider Preventable Conditions. Provider Satisfaction Survey shall have the meaning ascribed to such term in Section 4.12.6 of this Agreement. Provider Workgroup means the workgroup consisting of representatives from each Centennial Care MCO, HSD, the Collaborative and Providers to work collaboratively to reduce administrative burdens on Providers by, among other things, standardizing forms and processes. Psychotropic Drugs and Medications means the therapeutic classes of drugs and the medications listed in Attachment 8 of this document, or the equivalent classes of drugs in other therapeutic classification systems. QM/QI means quality management and quality improvement. Quantitative Treatment Limits (QTL) Numerical limits on benefits or services based on frequency of treatment, number of days, days of coverage, days in a waiting period or similar limits on treatment scope or duration. RAC means the Medicaid Recovery Audit Contractor.
Prospective Payment System or “PPS” means a cost-based, per clinic rate that applies uniformly to all CCBHC services rendered by a certified clinic, including those delivered by qualified satellite facilities established prior to April 1, 2014. In demonstration year one (DY1), the state uses cost and visit data from the demonstration planning phase, updated by the Medicare Economic Index (MEI) to create the rate for DY1. The DY1 rate will be updated again for future demonstration years by rebasing the PPS rate.
Prospective Payment System or “PPS” means the Medicare prospective payment system under which a provider is paid a predetermined amount per patient, either per day or per encounter, based on the anticipated costs of treating a patient (rather than on a retrospective cost-based methodology) by classifying each patient into certain clinical categories reflecting the patient’s acuity level;
Prospective Payment System means a predetermined amount of reimbursement per day for inpatient hospital services.
Prospective Payment System means a system of classi- fying episodes of care for billing and reimbursement pur- poses, based on factors such as diagnoses, age, and sex.
Prospective Payment System. (PPS): A method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount. The payment amount for a particular service is derived based on the classification system of that service (for example, DRGs for inpatient hospital services). CMS uses separate PPSs for reimbursement to acute inpatient hospitals, home health agencies, hospice, hospital outpatient, inpatient psychiatric facilities, inpatient rehabilitation facilities, long-term care hospitals, and skilled nursing facilities. Provider: Any physician, hospital, facility, or other Health Care Professional who is licensed or otherwise authorized to provide Health Care services in the State or jurisdiction in which they are furnished. Provider Complaint: A written expression by a Provider, which indicates dissatisfaction or dispute with the Contractor’s policies, procedures, or any aspect of a Contractor’s administrative functions, including a Proposed Action.