Common use of Outpatient Treatment Clause in Contracts

Outpatient Treatment. DoD will reimburse DVA facilities CHAMPUS Maximum Allowable Charge (CMAC) minus 10 percent. For those services without a CMAC, DVA will be reimbursed at actual DVA cost. DVA reserves the right to periodically review DVA costs against the CMAC minus 10 percent reimbursement levels for an approval determination of an alternate reimbursement methodology for outpatient care by the DVA/ DoD Financial Management Workgroup. At a minimum, the billing will be itemized for each member on Centers for Medicare and Medicaid (CMS) Form 1500 for outpatient services and Universal Billing (UB) Form UB04 for outpatient facility charges.

Outpatient Treatment. DoD will reimburse DVA facilities CHAMPUS Maximum Allowable Charge (CMAC) minus 10 percent. For those services without a CMAC, DVA will be reimbursed at actual DVA cost. DVA reserves the right to periodically review DVA costs against the CMAC minus 10 percent reimbursement levels for an approval determination of an alternate reimbursement methodology for outpatient care by the DVA/ DVA/DoD Financial Management Workgroup. At a minimum, the billing will be itemized for each member on Centers for Medicare and Medicaid (CMS) Form 1500 for outpatient services and Universal Billing (UB) Form UB04 for outpatient facility charges.