Calculation to determine the reasonable cost incurred by individual providers when furnishing covered services to beneficiaries. Reasonable cost is based on the actual cost of providing such services including direct and indirect costs of providers, excluding any costs that are unnecessary in the efficient delivery of services covered by a health insurance program.
Insurance Encyclopedia
Reasonable cost methodology
System used by Medicare fiscal intermediaries under established guidelines from the Centers for Medicare and Medicaid Services (CMS) to find the reasonable cost incurred by the provider when rendering services to a Medicare patient. These guidelines try to exclude unnecessary medical costs.
Reasonable Despatch
Under marine Insurance contracts it is a condition of the transit Insurance that the assured shall act with reasonable despatch in all circumstances within their control.
Reasonable Despatch Clause/Avoidance of Delay Clause
Institute Cargo Clause making it a condition that the insured shall act with reasonable despatch in all circumstances under his control. Cover runs while the goods are in ordinary transit but if the insured chooses to interrupt the transit, the insurance terminates at the place of the interruption.
Reasonable fee
Amount on which payment is based for participating physicians in the Medicare program; a charge is considered reasonable if it is deemed acceptable after peer review even though it does not meet the customary or prevailing criteria. This would include unusual circumstances or complications requiring additional time, skill, or experience in connection with a particular service or procedure.
Reasonable man
The objective test in negligence is based on the ‘acts or omissions’ of the reasonable man – the ‘man on the Clapham omnibus who does ‘not have to possess the wisdom of a Hebrew Prophet or the agility of an acrobat’. No person is an ‘insurer’ of his fellow men – there has to be fault, which, in negligence, means falling below the standard of the reasonable man.
Reasonable Man Test
Under common law, or as defined by statutes applicable to particular situations, a standard of conduct that is sufficient to precluded liability. the “reasonable man” test is most frequently applied in situations involving alleged negligence.
Reasonable medical probability
Legal phase used when proving the cause of an injury that means the injury was more likely than not caused by a certain agent or factor.
Reasonable Precaution Clause
A clause found in various classes of insurance policies that requires the insured to take reasonable precautions to guard against the occurrence of a loss.
Reasonable-expectation doctrine
See: doctrine of reasonable expectations .