Payment Methodologies i) Description prepared annually of the types of methodologies the plan uses to reimburse providers, specifying the type of methodology used to reimburse particular types of providers or for the provision of particular types of services.
Payment Methodologies. Direct Care Services will be reimbursed according to the following payment methods and rates: • Inpatient hospital services are based on Medicare Inpatient Prospective Patient System. • Outpatient services will be based on the IHS All Inclusive Rate posted in the Federal Register. • Critical Access Hospitals will be reimbursed at the established rate as determined by Medicare. • Ambulatory Surgical Services will be reimbursed at Medicare rates. • Administrative fees in the amount of $15 on outpatient claims will be applied for the first two years. Paper claims will also incur a $15 fee for the duration of agreements. VA will work cooperatively with IHS and THPs to ensure access to quality care for AI/AN Veterans. To that end, these reimbursement agreements integrate the following: • Information Exchange – VA and IHS/THPs shall develop a process to share patient records consistent with relevant privacy laws and will continue activities to share data electronically. • Collaboration – VA and IHS/THPs shall promote quality health care services through collaboration activities to review, measure and report on quality of care delivered.
Payment Methodologies. HCA will reimburse a Third Party Administrator (TPA) for the CSS and IPS services provided at the CSS and IPS rates. The rates shall not exceed the amount expended by the TPA for the direct service costs incurred by the provider. Rates may vary by region and may be developed based on a target cost per CSS and IPS service, along with variables such as geographic location, FCS-related travel costs, intensity of services, and duration of services or contracted provider per unit costs.
Payment Methodologies. Must tribal health programs have billing capabilities in order to receive reimbursement?
Payment Methodologies. The Payment Methodology establishes the manner in which Consultant will receive compensation payments. There are four Payment Methodologies applicable to this Agreement. Three of these Payment Methodologies apply to Work Orders with the Fixed Price Based Pricing Methodology: Percentage of Completion Basis Means that Consultant will be paid in a series of payments, not more than monthly in frequency. The amounts of these payments shall be based upon the Judicial Council’s Project Manager’s determination of the percentage of the total Work that was performed in the previous calendar month. Schedule of Values Means that Consultant will be paid in a series of payments of pre-defined amounts specified in the Schedule of Values established in the Work Order. Payments that will be made only when a Deliverable listed in the Schedule of Values has been accepted, or a Service listed in the Schedule of Values has been successfully performed and accepted. Lump Sum Payment Means that Consultant will be paid in a single payment that will be made only when all Deliverables have been accepted and all Services successfully performed and accepted. Time and Materials Based Payment Methodology All Work Orders utilizing the Time and Materials Based Pricing Methodology use the Time and Materials Based Payment Methodology. The Time and Materials Based Payment Methodology means that Consultant will be paid in a series of payments for: Hours of Work actually performed by Consultant’s and Sub-Consultant’s employees during the previous calendar month, to be invoiced at the Hourly Rates specified in the Work Order; If allowed for in the Work Order, Travel and Living Expenses actually incurred by Consultant’s and Sub-Consultant’s employees during the previous calendar month, to be invoiced at Actual Cost paid by Consultant; If allowed for in the Work Order, Reimbursable Items actually purchased by Consultant’s or its Sub-Consultant(s) during the previous calendar month, to be invoiced at Actual Cost paid by Consultant; If allowed for in the Work Order, Consultant’s own employees Travel Time Costs actually incurred by Consultant’s employees during the previous calendar month, to be invoiced at Hourly Rates for Consultant’s own employees specified in the Work Order; and If allowed for in the Work Order, Consultant’s Sub-Consultants’ employees Travel Time Costs actually incurred by Sub-Consultant’s employees during the previous calendar month, to be invoiced at Hourly Rates for Sub-Consu...
