DEFINITIONS AND OTHER TERMS AND CONDITIONS Clause Samples
The "Definitions and Other Terms and Conditions" clause establishes the specific meanings of key terms used throughout the contract and sets out additional provisions that govern the agreement. This clause typically lists important words or phrases and clarifies their intended interpretation, ensuring that all parties have a shared understanding of the contract language. By providing clear definitions and supplementary terms, this clause helps prevent misunderstandings and disputes over ambiguous language, thereby promoting clarity and consistency in the application of the contract.
DEFINITIONS AND OTHER TERMS AND CONDITIONS. A. Aetna Medicaid Market Fee Schedule (AMMFS) is defined as a fee schedule that is based upon the contracted location where service is performed and the applicable State Medicaid Fee Schedule.
B. Dialysis Services Payment is defined as the current payment that Provider will receive from Company for dialysis services based on CMS's ESRD Prospective Payment System (PPS).
C. Home Health Care Services Payment is defined as the current payment that Provider will receive from Company for home health care services based on the CMS Home Health prospective payment system (PPS).
DEFINITIONS AND OTHER TERMS AND CONDITIONS. Aetna Medicaid Market Fee Schedule (AMMFS) is defined as a fee schedule that is based upon the contracted location where service is performed and the applicable State Medicaid Fee Schedule. Aetna Medicare-Medicaid Plan Market Fee Schedule (AMMPMFS) is defined as a fee schedule that is based upon the contracted location where service is performed and the applicable Medicare Allowable Payment (Inpatient Services), Medicare Allowable Payment (Outpatient Services), Dialysis Services Payment, Home Health Care Services Payment, or Medicare Physician Fee Schedule (as applicable). Medicare Allowable Payment (Inpatient Services) is defined as the current payment as of discharge date that a hospital will receive from Company, subject to the then current Medicare Inpatient Prospective Payments Systems and will be updated in accordance with CMS changes, provided, however, that exempt units for psychiatric, rehabilitation and skilled nursing facility services will be paid in accordance with the applicable Medicare Prospective Payment Systems. These payments are intended to mirror the payment a Medicare Administrative Contractor (MAC) would make to the hospital, less (with respect to DRG-based payments) the payments for Operating Indirect Medical Education (IME), Direct Graduate Medical Education (DGME) and adjustments due to Company payment and processing guidelines. The current Medicare Allowable payment is final and is exclusive of cost settlements, reconciliations, or any other retroactive adjustments as completed by a MAC for both overpayments and underpayments. Medicare Allowable Payment (Outpatient Services) is defined as the current payment that Provider will receive from Company for outpatient services or procedures, pursuant to the Outpatient Prospective Payment System (OPPS), where applicable payment for these services is geographically adjusted using the provider-specific wage index. The Medicare Allowable Payment (Outpatient Services) is subject to Company’s payment and processing guidelines and is final and will not be impacted by cost settlements, reconciliations, or any other retroactive adjustments performed by a Medicare Administrative Contractor (MAC) for both overpayments and underpayments. Pursuant to CMS rules, specific revenue codes are packaged when billed without HCPCS codes. Payment for these dependent, ancillary, supportive, and adjunctive items and services is packaged into payment for the primary independent service reported with an applicab...
DEFINITIONS AND OTHER TERMS AND CONDITIONS. A. Aetna Medicaid Market Fee Schedule (AMMFS) is defined as a fee schedule that is based upon the contracted location where service is performed and the applicable State Medicaid Fee Schedule.
B. Rural Health Clinic (RHC) Encounter Rates - Payment for Covered Services shall be made in accordance with CMS methodology for Facility type. Company shall reimburse Facility equal to Facility's current encounter rate. Company will comply with CMS and OHCA regulations in administering reimbursement amounts and equal the total allowable rate, less applicable copayment or deductible amounts.
C. Dialysis Services Payment is defined as the current payment that Provider will receive from Company for dialysis services based on CMS's ESRD Prospective Payment System (PPS).
D. Home Health Care Services Payment is defined as the current payment that Provider will receive from Company for home health care services based on the CMS Home Health prospective payment system (PPS).
DEFINITIONS AND OTHER TERMS AND CONDITIONS. Aetna Medicaid Market Fee Schedule (AMMFS) is defined as a fee schedule that is based upon the contracted location where service is performed and the applicable State Medicaid Fee Schedule.