Risk adjustment prospective payment system used by Centers for Medicare and Medicaid Services (CMS) for managed care organizations (MCOs). It uses a hierarchical diagnosis classification system and other demographic adjusters to foretell costs and establish payment amounts for managed care services to Medicare beneficiaries.
Insurance Encyclopedia
Hierarchy
Numerical order of diagnostic codes in which each digit beyond three digits adds information. See Box H-3 .Box H-3ALPHANUMERICAL CODES FOR ICD-10-CMFRACTURE OF UPPER LIMB (810-819)810 Fracture of clavicleIncludes: collar boneinterligamentous part of clavicleThe following fifth-digit subclassification is for use with category 810:0 unspecified partClavicle NOS1 sternal end of clavicle2 shaft of clavicle3 acromial end of clavicle 810.0ICD-10-CMS42.00 Closed fracture of clavicleS42.001 Closed fracture of right clavicleS42.002 Closed fracture of left clavicleS42.009 Closed fracture of clavicle, unspecified side
high complexity (HC)
Phrase used to describe a type of medical decision making when a patient is seen for an E/M service.
High Deductible Health Plan (HDHP)
A health insurance plan that carries deductibles and out-of-pocket expense limits that are higher than certain IRS-mandated limits.
High level reinsurance
(1) reinsurance with a large excess; (2) in the context of a reinsurance spiral, it means that the reinsurer is many steps away from the direct insurer.
High Pressure Selling
The action of encouraging the buyer to purchase Insurance without full consideration of needs for Insurance and his liability to payments for the Insurance.
High risk
A high chance of loss.
High Risk Automobile Insurer
Company that specializes in insuring motorists who have poor driving records or have been canceled or refused insurance.
High risk property
A term in household contents policies, typically defined as: ‘jewellery, precious stones or articles made of gold, silver or other precious metals, clocks, watches, photographic equipment (not for commercial use), binoculars, telescopes and the like, musical instruments, antiques, curios and works of art, stamps and coin collections. They are high value/small bulk items attractive to thieves. The purpose of the definition is to assign to such property a separate sum insured, e.g. £5,000, as a sublimit of the overall contents figure and a single article limit, e.g. £1,500.
High-cost alternative
See: assumptions .