US: Coverage for a professional practitioner, such as a doctor or a lawyer, against liability claims resulting from alleged malpractice in the performance of professional services.
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UK: Describes the professional indemnity insurance issued to doctors, nurses, surgeons, hospitals and practitioners of complementary therapists. The term is also used more generally in the US as an alternative for professional indemnity.
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Liability insurance for professionals, such as Medical Practitioners, Chartered Accountants, Solicitors, Interior Decorators and such other professionals. See Also: “Professional indemnity Insurance” and “Professional indemnity, standard of care defined.”
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MEDICAL,USA: Professional liability insurance coverage for a physician against the risk of suffering financial damage because of professional negligence, misconduct, or lack of standard skills. Sometimes referred to as medical malpractice insurance, professional liability insurance (PLI) , or liability insurance .
Insurance Encyclopedia
Malpractice insurance (Liability Insurance)
Insurance that covers a medical practitioner in the event he or she is charged with malpractice. The insurance will pay damages as ordered by the court, and defend the insured in suits brought against them.
Malpractice reform
Effort to lower costs in health care by reducing the number of lawsuits against physicians and other health care providers and/or the amounts awarded in such lawsuits.
Malus
A penalty addition to an insurance premium because one or more claims have been made.
Mammogram
Special x-ray of the breasts. Medicare covers the cost of a mammogram once a year for women older than age 40.
managed behavioral health program (MBHP)
Program in a managed care organization (MCO) under a carve-out arrangement that provides services to the members such as behavioral services, utilization management services, or organizing an employee assistance program (EAP).
Managed care
MEDICAL,USA: 1. System of health care delivery designed to reduce unnecessary utilization of medical services, control costs, and measure performance while managing access and giving quality, cost-effective health care. Emphasis is placed on prevention, early intervention, and outpatient care. A variety of arrangements for health care delivery and financing includes health maintenance organizations (HMOs), preferred provider organizations (PPOs), point-of-service (POS) plans, and competitive medical plans (CMPs). The plans provide health services on prepayment terms that are based on either cost or risk. 2. Reimbursement method by third-party payers who implement some requirements to control costs of health care while retaining quality care. 3. Under Medicare, includes HMOs, CMPs, and other plans that provide health services on prepayment terms, which are based on either cost or risk, depending on the type of contract they have with Medicare. The term managed care has been replaced with Senior Advantage plans . See also Medicare Plus (+) Choice (M+C) program and Senior Advantage plans . Also called managed health care .
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US: Health care systems that integrate the financing and delivery of appropriate health care services to covered individuals by arrangements with selected providers to furnish a comprehensive set of health care services, explicit standards for selection of health care providers, formal programs for ongoing quality assurance and utilization review, and significant financial incentives for members to use providers and procedures associated with the plan.22424
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Systems designed to integrate the delivery and financing of health care of the highest possible quality at the lowest possible cost. In contrast to traditional fee for service arrangements, under managed care, health providers ,1. agree to negotiated payment levels for specified services to defined patient populations ,2. agree to more aggressive utilization and quality assurance review and ,3. assume financial risk leading to more severe restriction on patient choice to obtain services outside the network.
Managed care (Health Insurance)
A plan that aims to manage the employer’s health care expenses by establishing guidelines for care providers and better methods for the employees to choose a provider.
Managed care committee
See: managed care coordinator .
Managed care coordinator
Individual or committee that receives managed care plan referral authorization requests and depending on precise rules can either approve or deny the request. Also may be known as managed care committee .