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USC — United States Code (A free website for the full text is at U.S. Code. This text is maintained by the U.S. Gov't Printing Office, but must be checked for revisions or amendments after its effective date.) USCA — United States Code Annotated; USCCAN — United States Code Congressional and Administrative News; USCS — United States ...
Anderson emphasized the difficulty of patients' ability to interpret the chargemaster in a subsequent 2012 article: "Furthermore, most of the items on the charge master file are written in code so that only the hospital administrators and a few experts in the field can interpret their meanings." [27]
Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
Before the pandemic, about 1 million South Carolinians were on Medicaid. Medicaid in SC added 300K people during COVID pandemic. Many could lose benefits this year
The ICD-10 Procedure Coding System (ICD-10-PCS) is a US system of medical classification used for procedural coding.The Centers for Medicare and Medicaid Services, the agency responsible for maintaining the inpatient procedure code set in the U.S., contracted with 3M Health Information Systems in 1995 to design and then develop a procedure classification system to replace Volume 3 of ICD-9-CM.
Those who are "medically indigent earn too much to qualify for Medicaid but too little to purchase either health insurance or health care." [3] Medically indigent people with significant illnesses face several barriers to health insurance. States like South Carolina came up with their own MIAP program to assist those who fall in the gaps. [4]
A Medically Unlikely Edit (MUE) is a US Medicare unit of service claim edit applied to Medical claims against a procedure code for medical services rendered by one provider/supplier to one patient on one day. Claim edits compare different values on medical claim to a set of defined criteria to check for irregularities, often in an automated ...
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