Outlier Threshold definition

Outlier Threshold means the Medicare outlier threshold used in determining high cost outlier payments.
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Outlier Threshold means a dollar amount by which the total billed charges on the claim must exceed the MS-DRG Allowable Fee in order to qualify for an additional Outlier amount.
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Outlier Threshold means the level of estimated cost for a claim that when exceeded for an inpatient stay triggers an outlier payment in addition to the DRG base payment;
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Examples of Outlier Threshold in a sentence

  • If a Hospital qualifies for an Outlier Payment, the Outlier Payment will equal the product of the Marginal Cost Factor and the amount by which the Discharge-Specific Case Cost exceeds the Discharge-Specific Outlier Threshold.

  • If the Episode-Specific Case Cost exceeds the Episode-Specific Outlier Threshold, then an APEC Outlier Component is computed equal to the Marginal Cost Factor set at 60%, multiplied by the difference between the computed Episode-Specific Case Cost and the Episode-Specific Outlier Threshold.

  • If the Episode-Specific Case Cost does not exceed the Episode-Specific Outlier Threshold, then the APEC Outlier Component is $0.In no case is an APEC Outlier Component payable if the Episode-Specific Total EAPG Payment is $0.

  • Geometric Mean 5 ÷ 10 = 0.5 Cost Outlier Threshold = (A + B) x C ($6,688.08 + $8,590.26) x 0.5 = $7,639.17 NOTE: If the LOS exceeds the geometric mean LOS, the outlier threshold shall be limited to the DRG base payment plus the fixed loss threshold (wage- adjusted).

  • The Hospital’s Discharge-Specific Case Cost exceeds the Discharge-Specific Outlier Threshold for that discharge; b.

  • The hospital’s DRG cost outlier payment equals the hospital’s estimated loss minus the DRG Outlier Threshold, times the marginal cost percentage.

  • We undertake that in case due to any change in facts or circumstances during the Bidding Process, we are attracted by the provisions of disqualification in terms of the provisions of this RFQ cum RFP, we shall intimate the Authority of the same immediately.

  • For all cases except post acute care special pay transfer DRGs ((Billed Charges x Cost-to-Charge Ratio (CCR)) - Cost Outlier Threshold) x Marginal Cost Factor 2.

  • DRG Base Payment x (1 + Indirect Medical Education (IDME) Factor) B = (Fixed Loss Threshold x [(Labor-Related Share x Wage Index) + Non-Labor-Related Share] x National Operating Standard Costs as a Share of Total Costs (NOSCASTC)) C = LOS ÷ Geometric Mean Cost Outlier Threshold = (A + B) x C NOTE: If the LOS exceeds the geometric mean LOS, the outlier threshold shall be limited to the DRG base payment plus the fixed loss threshold (wage- adjusted).

  • Fixed Loss Threshold x [(Labor-Related Share x Wage Index) + Non-Labor-Related Share] x NOSCASTC) C = ((LOS ÷ Geometric Mean) + 1) x 0.5 Cost Outlier Threshold = (A + B) x C NOTE: If the LOS exceeds the geometric mean LOS, the outlier threshold shall be limited to the DRG base payment plus the fixed loss threshold (wage- adjusted).


More Definitions of Outlier Threshold

Outlier Threshold means a dollar amount published by CMS by which the total billed charges on the claim must exceed the MS-LTC-DRG Allowable Fee in order to qualify for an outlier allowable fee.
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Outlier Threshold means the Medicare outlier threshold used in determining high cost out- lier payments.
Sample 1Sample 2
Outlier Threshold means a dollar amount by which the total billed charges on the claim must exceed the MS-DRG Allowable Fee in order to qualify for an additional Outlier amount.‌
Sample 1

Related to Outlier Threshold

  • Threshold means with respect to Party B: infinity.

  • stipulated minimum threshold means that portion of local production and content as determined by the Department of Trade and Industry; and

  • Covered Debt Amount means, on any date, the sum of (x) all of the Revolving Credit Exposures of all Lenders on such date plus (y) the aggregate principal amount (including any increase in the aggregate principal amount resulting from payable-in-kind interest) of Other Covered Indebtedness outstanding on such date.