Provider Preventable Condition definition

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, ▇▇▇▇▇, 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.

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Provider Preventable Condition has the meaning provided for in 42 CFR 447.26(b).

Provider Preventable Condition means a health care

Examples of Provider Preventable Condition in a sentence

Provider Preventable Condition means a condition that meets the definition of a Health Care- Acquired Condition or an Other Provider-Preventable condition.
The Contractor’s policies and procedures shall also be consistent with the following: The Contractor shall not pay a provider for a Provider Preventable Condition.
Provider Preventable Condition – Health care-acquired condition means a condition occurring in a hospital setting, identified as HAC in the State Plan as described in Section 1886(d)(4)(D)(ii) and (iv) of the Social Security 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.
Provider Preventable Condition - A hospital acquired condition or a condition occurring in any health care setting that 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, has a negative consequence for the Enrollee, and is auditable.
The Contractor‘s policies and procedures shall also be consistent with the following: The Contractor shall not pay a provider for a Provider Preventable Condition.
Provider Preventable Condition - A hospital acquired condition or a condition occurring in any health care setting that has been found by SCDHHS, based upon a review of medical literature by qualified professionals, to be reasonably preventable through the application of procedures supported by evidence-based guidelines, has a negative consequence for the Enrollee, and is auditable.
In general, all Users in the Falls Church Contract Service Area shall be served by sewers owned, operated, and maintained by that jurisdiction, unless there is mutual agreement of the jurisdictions to the contrary.
A Contractor may limit reductions in Provider payments to the extent that the following apply: The identified Provider Preventable Condition would otherwise result in an increase in payment.
The Contractor shall not impose any reduction in payment for a Provider Preventable Condition when the condition defined as a Provider Preventable Condition for a particular Enrollee existed prior to the Provider’s initiation of treatment for that Enrollee.
An ICO may limit reductions in provider payments to the extent that the following apply The identified Provider Preventable Condition would otherwise result in an increase in payment; The ICO can reasonably isolate for nonpayment the portion of the payment directly related to treatment for, and related to, the Provider Preventable Condition.

More Definitions of 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 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 (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.

Provider Preventable Condition means a condition that meets the

Provider Preventable Condition means a condition that meets either of the following criteria: