Hospital - Inpatient Stay Sample Clauses

Hospital - Inpatient Stay. Services and supplies provided during an Inpatient Stay in a Hospital. Benefits are available for: • Supplies and non-Physician services received during the Inpatient Stay. • Room and board in a Semi-private Room (a room with two or more beds). • Physician services for radiologists, anesthesiologists, pathologists and Emergent ER Services Physicians. (Benefits for other Physician services are described under Physician Fees for Surgical and Medical Services.)
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Hospital - Inpatient Stay. Emergency Room Expenditures Although a person may have indicated that there was an emergency room visit that preceded this hospital stay (EMERROOM), there was no verification that, in fact, the emergency room visit was actually recorded within the Emergency Room Section of the questionnaire. While it is true that all of the event files can be linked by DUPERSID, there is no unique record link between hospital inpatient stays and emergency room visits. That is, a person could have one hospital inpatient stay and three emergency room visits during the calendar year. While the hospital inpatient stay record may indicate that it was preceded by an emergency room visit, there is no unique record link to the appropriate (of the three) emergency room visit.
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Hospital - Inpatient Stay. Data Editing and Imputation Facility expenditures for hospital inpatient stays were developed in a sequence of logical edits and imputations. “Household” edits were applied to sources and amounts of payment for all events reported by HC respondents. “MPC” edits were applied to provider-reported sources and amounts of payment for records matched to household-reported events. Both sets of edits were used to correct obvious errors (as described above) in the reporting of expenditures. After the data from each source were edited, a decision was made as to whether household- or MPC- reported information would be used in the final editing and imputations for missing expenditures. The general rule was that MPC data would be used for events where a household-reported event corresponded to a MPC-reported event (i.e., a matched event), since providers usually have more complete and accurate data on sources and amounts of payment than households. Separate imputations were performed for flat fee and simple events. Most hospital inpatient stays were imputed as simple events because facility charges for an inpatient hospital stay are rarely grouped with other events. (See Section 2.5.4 for more details on flat fee groups.) Logical edits also were used to sort each event into a specific category for the imputations. Events with complete expenditures were flagged as potential donors for the predictive mean matching imputations, while events with missing expenditure data were assigned to various recipient categories. Each event with missing expenditure data was assigned to a recipient category based on the extent of its missing charge and expenditure data. For example, an event with a known total charge but no expenditure information was assigned to one category, while an event with a known total charge and partial expenditure information was assigned to a different category. Similarly, events without a known total charge and no or partial expenditure information were assigned to various recipient categories. The logical edits produced eight recipient categories in which all events had a common extent of missing data. Separate predictive mean matching imputations were performed on events in each recipient category. For hospital inpatient events, the donor pool was restricted to events with complete expenditures from the MPC. The donor pool included “free events” because, in some instances, providers are not paid for their services. These events represent charity care, bad ...
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Hospital - Inpatient Stay. Emergency Room Expenditures Although a person may have indicated that there was an emergency room visit that preceded this hospital stay (EMERROOM), there was no verification that, in fact, the emergency room visit was actually recorded within the Emergency Room section of the questionnaire. While it is true that all of the event files can be linked by DUPERSID, there is no unique record link between hospital inpatient stays and emergency room visits. That is, a person could have one hospital inpatient stay and three emergency room visits during the calendar year. While the hospital inpatient stay record may indicate that it was preceded by an emergency room visit, there is no unique record link to the appropriate (of the three) emergency room visit. However, wherever relationships could be identified (using the MPC start and end date of the events as well as other information from the provider), the facility expenditure associated with the emergency room visit was moved to the hospital facility expenditure. Hence, for some hospital stays, facility expenditures for a preceding emergency room visit are included. In these situations, the corresponding emergency room record on the MEPS 2012 Emergency Room Visits File will have its facility expenditure information zeroed out to avoid double-counting.
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Hospital - Inpatient Stay. Services and supplies provided during an Inpatient Stay in a Hospital. Benefits are available for: • Supplies and non-Physician services received during the Inpatient Stay. • Room and board in a Semi-private Room (a room with two or more beds). • Physician services for radiologists, anesthesiologists, pathologists and Emergency room Physicians. (Benefits for other Physician services are described under Physician Fees for Surgical and Medical Services.) Sample • Voluntary termination of pregnancy (abortion). • Sterilization procedure for a female Covered Person when performed as the primary procedure for family planning reasons. • Anesthesia services that are related to covered surgery. This includes those services that are furnished for you by a Physician other than the attending Physician; or by a certified registered nurse anesthetist. • Radiation and x-ray therapy that is furnished for you by a Physician. This includes: radiation therapy using isotopes, radium, radon, or other ionizing radiation; and x-ray therapy for cancer or when used in place of surgery.
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Hospital - Inpatient Stay. SAMPLE Services and supplies provided during an Inpatient Stay in a Hospital. Benefits are available for: • Supplies and non-Physician services received during the Inpatient Stay. • Room and board in a Semi-private Room (a room with two or more beds) or a private room when Medically Necessary. • Physician services for radiologists, anesthesiologists, pathologists and Emergent ER Services Physicians. (Benefits for other Physician services are described under Physician Fees for Surgical and Medical Services.) With respect to treatment of breast cancer and other breast conditions, we will pay Benefits for an Inpatient Stay of at least: • 48 hours following a mastectomy, • 24 hours following a lymph node dissection.
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Hospital - Inpatient Stay. Note: Any deductible, copayment, and/or coinsurance, whichever applies to you, will be waived for the sterilization procedure for a female member when performed as the primary procedure for family planning reasons. $500 per Inpatient Stay for services provided with a referral to the admitting Network Specialist or other Network Physician from your Primary Care Provider Yes No
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Hospital - Inpatient Stay. A. The following Utilization Management requirements must be met to qualify for benefits:
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Hospital - Inpatient Stay. Services and supplies provided during an Inpatient Stay in a Hospital. Benefits are available for: • Supplies and non-Physician services which are customarily provided in acute care hospitals for an Inpatient Stay. • Room and board in a Semi-private Room (a room with two or more beds). • Room and board in a private room and inpatient private duty nursing when Medically Necessary. • Physician services for radiologists, anesthesiologists, pathologists and Emergent ER Services Physicians. (Benefits for other Physician services are described under Physician Fees for Surgical and Medical Services.) • Drugs, medications, biologicals, fluids, blood and blood products. Inpatient hospital services also include birthing centers.
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Related to Hospital - Inpatient Stay

  • Hospital This plan covers behavioral health services if you are inpatient at a general or specialty hospital. See Inpatient Services in Section 3 for additional information. Residential Treatment Facility This plan covers services at behavioral health residential treatment facilities, which provide: • clinical treatment; • medication evaluation management; and • 24-hour on site availability of health professional staff, as required by licensing regulations. Intermediate Care Services This plan covers intermediate care services, which are facility-based programs that are: • more intensive than traditional outpatient services; • less intensive than 24-hour inpatient hospital or residential treatment facility services; and • used as a step down from a higher level of care; or • used a step-up from standard care level of care. Intermediate care services include the following: • Partial Hospital Program (PHP) – PHPs are structured and medically supervised day, evening, or nighttime treatment programs providing individualized treatment plans. A PHP typically runs for five hours a day, five days per week. • Intensive Outpatient Program (IOP) – An IOP provides substantial clinical support for patients who are either in transition from a higher level of care or at risk for admission to a higher level of care. An IOP typically runs for three hours per day, three days per week.

  • Hospital Services The Hospital will:

  • Prosthodontics We Cover prosthodontic services as follows: • Removable complete or partial dentures, for Members 15 years of age and above, including six (6) months follow-up care; • Additional services including insertion of identification slips, repairs, relines and rebases and treatment of cleft palate; and • Interim prosthesis for Members five (5) to 15 years of age. We do not Cover implants or implant related services. Fixed bridges are not Covered unless they are required: • For replacement of a single upper anterior (central/lateral incisor or cuspid) in a patient with an otherwise full complement of natural, functional and/or restored teeth; • For cleft palate stabilization; or • Due to the presence of any neurologic or physiologic condition that would preclude the placement of a removable prosthesis, as demonstrated by medical documentation.

  • Hospice Care If you have a terminal illness and you agree with your physician not to continue with a curative treatment program, this plan covers hospice care services received in your home, in a skilled nursing facility, or in an inpatient facility.

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