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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 ...
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) instructed CMS to adopt a standard coding systems for reporting medical transactions. The use of Level III codes was discontinued on December 31, 2003, in order to adhere to consistent coding standards.
Stakeholders have raised significant questions about health benefits of currently covered items or services; New evidence, or re-interpretation of previously available evidence indicates that current policies may need to be changed; Local coverage policies are inconsistent or conflicting, to the detriment of beneficiaries; For new items or services
An explanation of benefits (commonly referred to as an EOB form) is a statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf. [1] The EOB is commonly attached to a check or statement of electronic payment. An EOB typically describes:
The U.S. Department of Health and Human Services (HHS) estimated that 20.0 million adults (aged 18–64) gained healthcare coverage via ACA as of February 2016; [6] similarly, the Urban Institute found in 2016 that 19.2 million non-elderly Americans gained health insurance coverage from 2010 to 2015. [203]
Salivary levels of valproic acid correlate poorly with serum levels, partly due to valproate's weak acid property (pKa of 4.9). [ 48 ] In severe intoxication, hemoperfusion or hemofiltration can be an effective means of hastening elimination of the drug from the body.
🚗 Say you have a 2010 Ford sedan worth $3,000 and your full-coverage insurance (collision and comprehensive) costs $800 per year with a $500 deductible. ... coverage levels vary by policy, so ...
The attitudinal underinsurance definition is recognized when; (1) at least one health benefit that the individual would prefer to receive is not covered by insurance, (2) when there is at least one symptom that the person believed required treatment for which insurance coverage treatment was not provided, or (3) when a person is dissatisfied ...