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A national coverage determination (NCD) [1] is a United States nationwide determination of whether Medicare will pay for an item or service. [2] It is a form of utilization management and forms a medical guideline on treatment.
Medicare has a number of policies that describe coverage criteria, including National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), [3] formerly known as Local Medical Review Policies (LMRP). [note 1] In a small number of cases, Medicare may determine if a method of treating a patient should be covered on a case-by ...
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 ...
In insurance, incurred but not reported (IBNR) claims is the amount owed by an insurer to all valid claimants who have had a covered loss but have not yet reported it.. Since the insurer knows neither how many of these losses have occurred, nor the severity of each loss, IBNR is necessarily an est
Creditable coverage" is defined quite broadly and includes nearly all group and individual health plans, Medicare, and Medicaid. [12] A "significant break" in coverage is defined as any 63-day period without any creditable coverage. [13] Along with an exception, it allows employers to tie premiums or co-payments to tobacco use, or body mass index.
Participation in the NFIP is based on an agreement between local communities and the federal government that states that if a community will adopt and enforce a floodplain management ordinance to reduce future flood risks to new construction in Special Flood Hazard Areas (SFHA), the federal government will make flood insurance available within the community as a financial protection against ...
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Most company-provided health insurance policies starting on or after September 23, 2010, and before September 23, 2011, may not set an annual coverage cap lower than $750,000, [153] a lower limit that is raised in stages until 2014, by which time no insurance caps are allowed at all. By 2014, no health insurance, whether sold in the individual ...