REIMBURSEMENT RATES FOR DIRECT CARE SERVICES Sample Clauses

REIMBURSEMENT RATES FOR DIRECT CARE SERVICES. A. Except to the extent inconsistent with the rate methodology explained herein, VA shall reimburse the IHS for Direct Care Services at rates based on Medicare payment methodologies. In the absence of Medicare rates and otherwise agreed upon rates specified herein, VA will pay the lesser of the local VA Fee Schedule amount or billed charges.

REIMBURSEMENT RATES FOR DIRECT CARE SERVICES. A. Except to the extent inconsistent with the rate methodology explained herein, VA shall reimburse the THP for direct care services at rates based on Medicare payment methodologies. In the absence of Medicare rates, VA will pay the lesser of the local VA fee schedule amount or billed charges. If there is no Medicare rate, and no local VA Fee schedule amount, VA will pay billed charges

REIMBURSEMENT RATES FOR DIRECT CARE SERVICES. A. Except to the extent inconsistent with the rate methodology explained herein, VA shall reimburse the THP for Direct Care Services at rates based on Medicare payment methodologies. In the absence of Medicare rates and otherwise agreed upon rates specified herein, VA will pay the lesser of the local VA Fee Schedule amount or billed charges. 1. Payment for inpatient hospital services will be based upon the applicable prospective payment system (PPS). For example, reimbursement for inpatient hospital services shall be made per discharge based on the applicable PPS used by the Medicare program to pay for similar hospital services under 42 C.F.R. Part 412. This methodology will be used under this Agreement to reimburse inpatient hospital services regardless of whether the THP hospital participates in the Medicare program or is otherwise exempt from the PPS (e.g., Critical Access Hospitals (CAHs)). 2. For hospitals that furnish inpatient services but are exempt from PPS and receive reimbursement based on reasonable costs, including provider subunits exempt from PPS, payment shall be made per discharge based on the reasonable cost methods established under 42 C.F.R. Part 413, except that the interim payment rate under 42 C.F.R. Part 413.70, subpart E shall constitute payment in full. 3. The inpatient rates set forth above do not include inpatient physician services and practitioner services. The inpatient physician and other practitioner services shall be reimbursed based on the Medicare physician fee schedule. C. Outpatient Hospital Services and Freestanding Clinic Services: VA shall reimburse outpatient hospital and free-standing clinics for services provided to Eligible American Indian/Alaska Native Veterans at the AIR.