4 5 7 A B C D E F G H I J K L M P Q R S T U V W X Y Z

Extension of benefits

See: Extended Benefits.
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A condition in the insurance policy which allows coverage to continue beyond the expiration date of the policy in the case of employees who are not actively at work or dependents who are hospitalized on that date. The extended coverage applies only where the employee or dependent is disabled as of that date and continues only until the employee returns to work or the dependent leaves the hospital.

External audit

Review done after claims of medical and financial records have been submitted by an insurance company or Medicare representative to investigate suspected fraudulent and abusive billing practices (retrospective review).

External Quality Review Organization (EQRO)

1. Federal regulations require states to use an EQRO to review the care provided by capitated managed care entities. EQROs may be a quality improvement organization (QIO) program, another entity that meets peer review organization requirements, or a private accreditation body. 2. Organization with which a state contracts to evaluate the care provided to Medicaid-managed eligibles. Typically, the EQRO is a peer review organization. It may conduct focused medical record reviews targeted at a specific clinical condition or broader analyses on quality. Although most EQRO contractors rely on medical records as the primary source of information, they may also use eligibility data and claims/encounter data to conduct specific analyses.

Extraterritorial

A review done after claims of medical and financial records have been submitted by an insurance company or Medicare representative to investigate suspected fraudulent and abusive billing practices (retrospective review).