Encounter Rate definition

Encounter Rate means the Encounter Rate set forth on the Order Form.

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Encounter Rate. The payment made to Medical Group for Covered Services rendered to a Customer during an encounter. Unless otherwise specified in this Appendix, such payment shall be considered payment in full, less any applicable Customer Expenses, for all Covered Services rendered to the Customer by the Medical Group. Payor shall pay Medical Group for covered Health Services rendered to Customers the lesser of (1) Medical Group’s Customary Charge, less any applicable Member Expense or (2) the applicable Case Rate less any applicable Member Expense.

Encounter Rate means the all-inclusive PPS rate that the Department reimburses an FQHC for an encounter pursuant to 42 USC 1396a (bb);

Examples of Encounter Rate in a sentence

• The rate of payment shall be set at the Encounter Rate established by the IHS on an annual basis and published in the Federal Register.

• All Covered Services* Encounter Rate* [****] * The Encounter Rate Payment includes payment in full for all services and supplies billed during an entire patient encounter.

• The Encounter Rate will be paid, less any applicable Customer Expenses, for all Covered Services rendered to the Customer by the Medical Group, only once every six months from the initial date of service to the Customer, or first date of service after a six month period has expired, whichever is later.

• FQHC / RHC – The lesser of 100% of current Medicare Encounter Rate or PP/PPG’s billed charges minus any applicable copays, coinsurance or deductibles.

• STG Encounter rate = (Average of (total number sighting/total effort) of 1st and 2nd completed survey# of 1st month+ Average of (total number sighting/total effort) of 1st and 2nd completed survey# of 2nd month + Average of (total number sighting/total effort) of 1st and 2nd completed survey# of 3rd month)/3*100km **Quarterly Average Encounter Rate of Total Number of Dolphins (ANI) presents averaged encounter rates of the three monitored months in terms of individuals per 100km per survey event.

• The Agreement must reimburse THPs for outpatient pharmacy services at the IHS All Inclusive Rate (AIR), also known as the Office of Management and Budget (OMB) Encounter Rate.

• FQHC / RHC – The lesser of 100% of current Medicaid Encounter Rate or PP/PPG’s billed charges minus any applicable copays, coinsurance or deductibles.

• The Percentage Fee, and the Encounter Rate shall only be applied to services and procedures performed on or after the First Charge Entry Date and until the Final Charge Submission Date; provided, however, that for Channel Transfer Clients, the Percentage Fee (or the Transferred A/R Percentage Fee, if applicable) shall in addition be applied to all charges existing in the Hosted Programs as of the First Charge Entry Date for which no payment has been posted.

• In addition, if Provider reimbursement is under one or more of the following methodologies: Capitation, Case Rate, DRG Rate, Encounter Rate, Global Case Rate, Per Diem Rate, Per Relative Value Unit, Per Service Rate, and Per Visit Rate, then individual services billed shall not be reimbursed separately, unless otherwise specified in Article IV of this PCS.

• Table 3.7 Summary of STG and ANI encounter rates in September - November 2014 NEL NWL Level Exceeded STG* 0 2.1 Limit ANI** 0 7.1 *Quarterly Average Encounter Rate of Number of Dolphin Sightings (STG) presents averaged encounter rates of the three monitored months in terms of groups per 100km per survey event.

More Definitions of Encounter Rate

Encounter Rate means the Anthem Rate that is all-inclusive of professional, technical and facility charges including evaluation and management, pharmaceuticals, routine surgical and therapeutic procedures, and diagnostic testing (including laboratory and radiology) capable of being performed on site. "Fee Schedule(s)" means the complete listing of Anthem Rate(s) for specific services that is payment for each unit of service allowed based on applicable Coded Service Identifier(s) for Covered Services.

Encounter Rate means the Wellpoint Rate that is all-inclusive of professional, technical and facility charges including evaluation and management, pharmaceuticals, routine surgical and therapeutic procedures, and diagnostic testing (including laboratory and radiology) capable of being performed on site. "Fee Schedule(s)" means the complete listing of Wellpoint Rate(s) for specific services that is payment for each unit of service allowed based on applicable Coded Service Identifier(s) for Covered Services.