1. A particular instance of injury or disease, as a case of leukemia; sometimes used incorrectly to designate the patient with the disease. 2. Entire plan of a group insurance policyholder.
Insurance Encyclopedia
Case by Case Estimation
A method of determining the reserve for outstanding reported claims. Each outstanding claim is individually assessed to arrive at an estimate of the total payment to be made.
Case history
Past and current clinical information that the physician wants to know about the patient. The case history becomes part of the patient’s health record.
Case Law
The part of the law which is found in the decision of the judge as reported to the various series of law reports.
Case managed
See: case management.
Case management
1. Ongoing review of cases by clinical professionals to ensure the necessity of the clinical services given and most appropriate use of services to a patient. Typically, case managers are nurses or social workers. They may operate privately or may be employed by social service agencies or public programs. 2. Process that integrates and coordinates patient care in complex and high-cost cases. Sometimes a patient is referred to as case managed. 3. Process of developing a defined health care plan for a patient for better communication and to improve quality of care and reduce costs. Case management is sometimes a “carve out.” See carve out. 4. In the Medicare program, an arrangement of services needed to give proper health care to a beneficiary; tracking of beneficiary’s use of facilities and resources. Also known as catastrophic case management, catastrophic claim management, large claim management, or medical case management.
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Case management is used to manage healthcare costs in workers compensation. The case manager works with the insured, the physician, and the employer to design the most cost-efficient treatment plan. Case managers also monitor the injured worker’s progress and keep the employer and insurance company informed about the worker’s ability to return to work.
Case Management, Health
The assessment of a person’s long term care needs and the appropriate recommendations for care, monitoring and follow-up as to the extent and quality of services to be provided.
Case manager
1. Clinical professional (nurse or social worker) who works with the patient and all those involved with the patient in coordinating a plan of medical necessity and appropriateness of health care. He or she reviews cases after a predetermined amount of time and certifies ongoing care. 2. Registered or licensed vocational nurse assigned to a workers’ compensation case to supervise the administration of medical or ancillary services provided to the patient.
Case Manager, Health
A person, usually an experienced professional, who coordinates the services necessary under the case management approach.
Case method/case reserve
Method of calculating the reserve for the outstanding reported claims. Each claim is assessed individually on the basis of the information available and the aggregated figure is included in the balance sheet.