Potpourri
The practice of charging higher fees to payment sources that impose fewer controls.
What is cost shifting?
These establish time periods for a party that has been wronged by another to bring a claim.
What are statutes of limitations?
These may arrive before any other medical documents and may come without being requested.
What are medical bills?
To be compensable, the bodily injury being claimed must be caused by the insured event, with this between them.
What is a direct chain of causation?
The abbreviation for motor vehicle accident.
What is MVA?
Care provided to relieve a patient’s pain.
What is palliative care?
The direction of the bodily injury investigation is typically determined by the type of injury and this.
What are the claim facts?
A claim representative should not only look at the status in a medical report, but also at the diagnosis and the physician’s plan and prognosis in the context of the general claim when completing this action.
What is setting claim reserves?
The claims representative reviews the claim file, including all documents and medical bills, paying close attention to the dates of the accident, injury descriptions, and treatment dates to determine this.
What is causation?
The medical term for an expensive operation that may require the replacement of the hip joint with a prosthesis, or artificial hip joint.
What is hip arthroplasty?
An injury management technique for allowing patients to continue enough physical activity to avoid complete disability while maintaining a tolerable comfort level.
What is activity modification?
Depending on the severity and complexity of the injury, a claim representative may assign this to assist in the investigation and management of the claim.
What is medical case management?
When loss of earnings is being claimed, the claim representative should also obtain from the injured person this.
What is a signed wage authorization form?
Reviewing the medical documents may reveal treatment for this. The medical bills for the knee include removal of warts, but it is highly unlikely that the accident caused the growth of warts on the knee.
What is a preexisting condition?
A common treatment method for sprains or an edible grain.
What is R.I.C.E, rest, ice, compression, and elevation?
A process for establishing preapproval for hospital admission or services (prospective review).
What is a preadmission certification?
The first step in the bodily injury investigation process.
What is identify and gather injury information and documents?
Federal legislation establishing standards for health insurance information exchanges and health coverage protection when jobs are lost or changed.
What is Health Insurance Portability and Accountability Act (HIPAA)?
When determining causation the claims representative should pay close attention to the dates of the accident and what other two items?
What are the injury descriptions and the treatment dates?
This book can be used to determine treatment and disability of injuries.
What is the Medical Disability Advisor(MDA)?
A policy that covers liability claims in excess of the limits of an underlying policy or stated retention amount.
What is an excess liability policy?
The early medical documents received typically include the following
What are emergency room reports, physician reports, x-ray and other diagnostic reports, and nursing reports.
The point at which no further medical progress or recovery is expected.
What is Maximum medical improvement (MMI)?
The following information should be asked of a health care provider when diagnostic codes do not match the injury claimed.
Why is there a discrepancy between the patient’s diagnosis and the injury claimed?
These are the four-steps in the medical investigation process.
1. Identify and gather injury information
2. Analyze records and reports
3. Assess treatment, disability, and impairment
And this final step.
What is monitor and update the plan?