Category: U

Pain in the uterus.  

Evaluation of the necessity, appropriateness and efficiency of the use of medical services, procedures and facilities. In a hospital this includes review of the appropriateness of admissions, services ordered and provided, length of stay, and discharge practices, both on a concurrent and retrospective basis. Utilization review can be done by a utilization review committee, PSRO,…

Use utilization is commonly examined in terms of patterns or rates of use of a single service or type of service, e.g., hospital care, physician visits, prescription drugs. Measurement of utilization of all medical services in combination is usually done in terms of dollar expenditures. Use is expressed in rates per unit of population at…

Health insurance plans that pay a physician’s full charge if: it does not exceed his usual charge; it does not exceed the amount customarily charged for the service by other physicians in the area (often defined as the 90 or 95 percentile of all charges in the community, or it is otherwise reasonable. In this…

A set of provisions regarding the nature and content of individual health insurance policies, developed in a recommended model law by the NAIC and adopted (with minor variations) by almost all jurisdictions and permitted in all.  

A defined set of data which give a minimum description of a hospital episode or admission. Collection of a UHDDS is required upon discharge for all hospital stays reimbursed under Medicare and Medicaid. The UHDDS was defined in a policy statement of the Secretary of HEW (HEW publication number HSM 73-1451, series 4, no. 14,…

The use of a common set of accounting definitions, procedures, terms, and methods for the accumulation and communication of quantitative data relating to the financial activities of several enterprises. The American Hospital Association, for example, encourages the use of its Chart of Accounts as a system which can be employed by hospitals in the United…

A form of social insurance that operates by means of a payroll tax, the revenues from which are used to pay calculated benefits for defined periods to people who qualify (usually by virtue of accumulated amounts of covered employment) as being unemployed, as defined in the law. Of interest because people receiving unemployment insurance do…

That portion of the earnings of an insurance company that comes from the function of underwriting. It excludes earnings from investments (other than interest earnings required by law or regulation to be assumed to have been earned for purposes of determining the reserves held) either in the form of income from securities or sale of…

In insurance, the process of selecting, classifying, evaluating and assuming risks according to their insurability. Its fundamental purpose is to make sure that the group insured has the same probability of loss and probable amount of loss, within reasonable limits, as the universe on which premium rates were based. Since premium rates are based on…