Payment of Physician Services for Trauma Care Sample Clauses

Payment of Physician Services for Trauma Care. ‌ The Contractor shall pay physician services for trauma care at the same rate as HCA for corresponding dates of service as set forth in WAC 183-531-2000 and published provider notices.
Sample 1
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Payment of Physician Services for Trauma Care. ‌ The Contractor shall pay physician services an enhancement for severe trauma care. If all criteria are met, the trauma enhancement must be at least 275% of the Contractor’s standard rate for the service. 5.22.1 To qualify for the trauma care enhancement, a service must meet all of the following criteria: 5.22.1.1 The service must be provided by a physician or clinician; 5.22.1.2 The service must be hospital-based, with a billed place of service 21, 22, 23, 24, 51, 52, or 56; 5.22.1.3 The service must be provided in a Department of Health designated or recognized trauma service center; and 5.22.1.4 The provider has indicated that the injury severity score (ISS) criteria has been met by billing with modifier ST in any position. The ISS must be: 5.22.1.4.1 Thirteen (13) or greater for clients age 15 and older; 5.22.1.4.2 Nine (9) or greater for clients younger than age 15; 5.22.1.4.3 Zero (0) or greater when the service is provided at a Level I, II, or III trauma service center when the trauma case is received as a transfer from another facility. 5.22.2 Rehabilitation and surgical services provided within six months of the date of an injury that meets all criteria in subsection 5.22.1 may also receive the enhancement rate if all of the following criteria are met: 5.22.2.1 The follow-up procedures are directly related to the qualifying traumatic injury; 5.22.2.2 The follow-up procedures were planned during the initial acute episode of care, i.e. the inpatient stay; and 5.22.2.3 The plan for the follow-up procedure(s) is clearly documented in the medical record of the client’s initial hospitalization for the traumatic injury.
Sample 1

Related to Payment of Physician Services for Trauma Care

  • Physician Visits This plan covers the services of a physician or other provider in charge of your medical care while you are inpatient in a general or specialty hospital.

  • Contract for Professional Services of Physicians Optometrists, and Registered Nurses

  • Diagnostic Services All necessary procedures to assist the dentist in evaluating the existing conditions to determine the required dental treatment, including: Oral examinations Consultations

  • Chiropractic Services This plan covers chiropractic visits up to the benefit limit shown in the Summary of Medical Benefits. The benefit limit applies to any visit for the purposes of chiropractic treatment or diagnosis.

  • Outpatient Services Physicians, Urgent Care Centers and other Outpatient Providers located outside the BlueCard® service area will typically require You to pay in full at the time of service. You must submit a Claim to obtain reimbursement for Covered Services.

  • Anesthesia Services This plan covers general and local anesthesia services received from an anesthesiologist when the surgical procedure is a covered healthcare service. This plan covers office visits or office consultations with an anesthesiologist when provided prior to a scheduled covered surgical procedure.

  • Inpatient Services Hospital Rehabilitation Facility

  • Hospice Services Services are available for a Member whose Attending Physician has determined the Member's illness will result in a remaining life span of six months or less.

  • Patient Care Resident shall participate in safe, effective, and compassionate patient care, under supervision, commensurate with Resident's level of advancement and responsibility.

  • Surgery Services This plan covers surgery services to treat a disease or injury when: • the operation is not experimental or investigational, or cosmetic in nature; • the operation is being performed at the appropriate place of service; and • the physician is licensed to perform the surgery. This plan covers reconstructive surgery and procedures when the services are performed to relieve pain, or to correct or improve bodily function that is impaired as a result of: • a birth defect; • an accidental injury; • a disease; or • a previous covered surgical procedure. Functional indications for surgical correction do not include psychological, psychiatric or emotional reasons. This plan covers the procedures listed below to treat functional impairments. • abdominal wall surgery including panniculectomy (other than an abdominoplasty); • blepharoplasty and ptosis repair; • gastric bypass or gastric banding; • nasal reconstruction and septorhinoplasty; • orthognathic surgery including mandibular and maxillary osteotomy; • reduction mammoplasty; • removal of breast implants; • removal or treatment of proliferative vascular lesions and hemangiomas; • treatment of varicose veins; or • gynecomastia.

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