Provider Preventable Condition means a health care
Provider Preventable Condition means a condition that meets either of the following criteria:
a) Is a Healthcare Acquired Condition. A Healthcare Acquired Condition is a condition listed below occurring in any inpatient hospital setting:
i. Foreign object retained after surgery;
ii. Air embolism;
iii. Blood incompatibility;
iv. Stage III and IV pressure ulcers;
v. Falls and trauma; including fractures, dislocations, intracranial injuries, crushing injuries, xxxxx, other injuries;
vi. Catheter-associated urinary tract infection (UTI);
vii. Vascular catheter-associated infection;
viii. Manifestations of poor glycemic control including diabetic ketoacidosis, nonketotic hyperosmolar coma, hypoglycemic coma, secondary diabetes with ketoacidosis, secondary diabetes with hyperosmolarity;
ix. Surgical site infection following coronary artery bypass graft (CABG)- Mediastinitis;
x. Surgical site infection following bariatric surgery for obesity, including laparoscopic gastric bypass, gastroenterostomy, laparoscopic gastric restrictive surgery;
xi. Surgical site infection following certain orthopedic procedures including spine, neck, shoulder, and elbow;
xii. Surgical site infection following cardiac implantable electronic device (CIED);
xiii. Deep vein thrombosis (DVT)/Pulmonary Embolism (PE) following total knee replacement or hip replacement with pediatric and obstetric exceptions; or
xiv. Latrogenic pneumothorax with venous catheterization.
b) Is an Other Provider-Preventable Condition. An Other Provider-Preventable Condition is a condition occurring in any health care setting that meets the following criteria:
i. Is identified in the State plan;
ii. Has been found by the State, based upon a review of the medical literature by qualified professionals, to be reasonably preventable through the application of procedures supported by evidence-based guidelines;
iii. Has a negative consequence for the beneficiary;
iv. Is auditable; and
v. At a minimum includes: • Wrong surgical or other invasive procedure performed on a patient; • Surgical or other invasive procedure performed on the wrong body part; • Surgical or other invasive procedure performed on the wrong patient.
Provider Preventable Condition has the meaning provided for in 42 CFR 447.26(b).
More Definitions of Provider Preventable Condition
Provider Preventable Condition means a health care acquired condition as defined under the federal Medicaid regulation found at 42 CFR 447.26 or an other provider-preventable condition.
Provider Preventable Condition means a condition that meets the definition of a Health Care- Acquired Condition or an Other Provider-Preventable condition. Rate Cell means a set of mutually exclusive categories of Enrollees that is defined by one or more characteristics for the purpose of determining the Capitation Rate and making a Capitation Payment; such characteristics may include age, gender, eligibility category, and region or geographic area. Each Enrollee is categorized in one of the Rate Cells for each unique set of mutually exclusive benefits under the Contract. Rating Period means a period of 12 months selected by the Department for which the actuarially sound Capitation Rates are developed and documented in the rate certification submitted to CMS as required by 42 CFR § 438.7(a).
Provider Preventable Condition has the meaning defined in 42 CFR 447.26(b).
Provider Preventable Condition means a condition that meets the
Provider Preventable Condition means a condition that meets either of the following criteria:
Provider Preventable Condition means a condition that meets the definition of a Health Care Acquired Condition (HCAC) or an Other Provider-Preventable Condition (OPPC).
Provider Preventable Condition means a condition that meets the definition of a health care-acquired condition — a condition occurring in any inpatient hospital setting, identified as a HAC by the Secretary under section 1886(d)(4)(D)(iv) of the Act for purposes of the Medicare program identified in the State Plan as described in section 1886(d)(4)(D)(ii) and (IV) of the Act; other than Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE) as related to total knee replacement or hip replacement surgery in pediatric and obstetric patients — or an “other provider- preventable condition,” which is defined as a condition occurring in any health care setting that meets the following criteria:
a) Is identified in the State Plan.
b) Has been found by the state, based upon a review of medical literature by qualified professionals, to be reasonably preventable through the application of procedures supported by evidence-based guidelines.
c) Has a negative consequence for the beneficiary.
d) Is auditable.
e) Includes, at a minimum, wrong surgical or other invasive procedure performed on a patient; surgical or other invasive procedure performed on the wrong body part; surgical or other invasive procedure performed on the wrong patient.