Monthly sum (factor) that is used to adjust incurred and paid insurance claims to expected incurred claims.

Physical restoration of damaged tissue when the wound requires more than layered closure as with scar revision, débridement (e.g., traumatic lacerations or avulsions), extensive undermining, stents, or retention sutures. Necessary preparation includes creation of a defect for repairs (e.g., excision of a scar requiring a complex repair) or the débridement of complicated lacerations or avulsions. Other examples are reconstructive surgery; complicated wound closure; skin grafting; intricate, unusual, and time-consuming methods to get maximum function and cosmetic results; and creation of a defect by extending excisions.

In reference to medical decision making, see straightforward (SF), low complexity (LC) , moderate complexity (MC), and high complexity (HC).

1. To satisfy federal mandates under the Health Insurance Portability and Accountability Act (HIPAA) by ensuring the physician or facility provides and bills for services according to the laws, regulations, and guidelines that govern it. 2. Degree to which a patient follows a treatment program directed by a physician or health care provider.
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UK: The process of following agreed or regulated procedures such as those laid down by the FSA concerning authorisations, regulated activities, conduct of business, etc. At Lloyd’s, the managing and members’ agents must comply with the requirements imposed upon them by Lloyd’s and supervised by the FSA (www.fsa.gov.uk).

Formal, methodical examination or review done to ensure compliance with all laws, HIPAA regulations, and guidelines. This is accomplished by inspecting, analyzing, and scrutinizing the way something is being done (e.g., bookkeeping practices, medical record documentation, insurance claim filing, diagnostic and procedural code selection).

Under HIPAA, those individuals in a facility or in a physician’s medical practice that are assigned to help the compliance officer teach and comply with all laws, regulations, and guidelines related to health care.

Under HIPAA, the date a covered entity must comply with a standard, an implementation specification, a requirement, or a modification. This is usually 24 months after the effective date of the associated final rule for most entities, but 36 months after the effective date for small health plans. For future changes in the standards, the compliance date would be at least 180 days after the effective date but can be longer for small health plans and for complex changes.

Target date when a final rule developed by the Secretary of Health and Human Services to meet a specific law under the Health Insurance Portability and Accountability Act (HIPAA) becomes mandatory and is strictly enforced.

Document published by the Office of the Inspector General (OIG) to enable hospitals, home health care, nursing homes, third-party billing companies, and physician medical practices to establish compliance programs.

Under the Health Insurance Portability and Accountability Act (HIPAA), to check provider and insurance company responsibilities in regard to the accuracy of procedure codes and verification of medical services provided to patients to prevent fraud and abuse.