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The first reported judicial decision involving an effort of a health insurer to seek subrogation on a personal injury claim is the 1982 decision in Frost v. Porter Leasing Corp., 436 N.E.2d 387 (Mass. 1982) in which subrogation was denied. “ERISA reimbursement” claims began arising in the late 1980s and have been resisted by some federal ...
Subrogation is the assumption by a third party (such as a second creditor or an insurance company) of another party's legal right to collect debts or damages. [1] It is a legal doctrine whereby one person is entitled to enforce the subsisting or revived rights of another for their own benefit. [ 2 ]
First, prefixes and suffixes, most of which are derived from ancient Greek or classical Latin, have a droppable vowel, usually -o-. As a general rule, this vowel almost always acts as a joint-stem to connect two consonantal roots (e.g. arthr- + -o- + -logy = arthrology ), but generally, the -o- is dropped when connecting to a vowel-stem (e.g ...
Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies, to manage the cost of health care benefits by assessing its medical appropriateness before it is provided, by using evidence-based criteria or guidelines.
Such coding is necessary for Medicare, Medicaid, and other health insurance programs to ensure that insurance claims are processed in an orderly and consistent manner. Initially, use of the codes was voluntary, but with the implementation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) use of the HCPCS for ...
Medical terminology is a language used to precisely describe the human body including all its components, processes, conditions affecting it, and procedures performed upon it. Medical terminology is used in the field of medicine .
Usual, customary, and reasonable (UCR) is an American method of generating health care prices, [1] described as "more or less whatever doctors decided to charge". [2] According to Steven Schroeder , Wilbur Cohen inserted UCR into the Social Security Act of 1965 "in an unsuccessful attempt to placate the American Medical Association ". [ 3 ]
Medical underwriting is a health insurance term referring to the use of medical or health information in the evaluation of an applicant for coverage, typically for life or health insurance. As part of the underwriting process, an individual's health information may be used in making two decisions: whether to offer or deny coverage and what ...