Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES
Chapter 29 - FEDERALLY-QUALIFIED HEALTH CENTERS (FQHC'S)
Section 471-29-003 - Payment for Services Provided by FQHCs

003.01 Definitions

The following definitions apply in this chapter.

Encounter means a face-to-face visit between a Medicaid-eligible patient and a physician, physician assistant, nurse practitioner, nurse midwife, specialized nurse practitioner, visiting nurse, clinical psychologist, or clinical social worker during which an FQHC service is rendered. Encounters with more than one health professional and multiple encounters with the same health professional which take place on the same day and at a single location constitute a single visit, except for cases in which the patient, subsequent to the first encounter, suffers an illness or injury requiring additional diagnosis or treatment.

Encounter Rate means the all-inclusive PPS rate that the Department reimburses the FQHC for an encounter.

Encounter Payments means PPS rate paid to the FQHC by the Department multiplied by the number of encounters billed.

Medicare Cost Report means the report filed by each provider with its Medicare intermediary as required in the Medicare Rural Health Clinic and Federal Qualified Health Center Manual.

Prospective Payment System (PPS) means the payment system where in the reimbursement rate is paid for services provided.