Measuring the presence or absence and amount of.

Referring to a test that determines the amount or percentage of an agent that is present within the body.

Phrase related to prescription drug insurance plans indicating restriction of the amount of medication for which the Medicare beneficiary can obtain benefits during a specific period of time (most often set on a monthly basis).

Request from an insurance company for additional information about a patient.

Under the Medicare program, medical procedures that may be a benefit depending on the medical situation. When a procedure listed in Medicare’s Outpatient Code Editor is billed, the insurance company must conduct a medical review of the claim to make a decision on payment. Formerly called development needed procedures .

Action to recover a penalty, brought by an informer in a situation in which one portion of the recovery goes to the informer and the other portion to the state or government. Also see qui tam provision and whistleblower .

Federal statute of the False Claims Act that allows any person having knowledge of a false claim against the government to bring an action against the suspected wrongdoer on behalf of the U.S. government. A person who files a qui tam suit on behalf of the government is known as a “relator” and may share a percentage of the recovery realized from a successful action. Also referred to as “whistleblower.” Also see whistleblower .

Estimates made once every 5 years of the costs arising from the granting of deemed wage credits for military service before 1957; annual reimbursements were made from the general fund of the U.S. Treasury to the health insurance (HI) trust fund for these costs. The Social Security Amendments of 1983 provided for (1) a lump-sum transfer in 1983 for (a) the costs arising from the pre-1957 wage credits and (b) amounts equivalent to the HI taxes that would have been paid on the deemed wage credits for military service for 1966 through 1983, inclusive, if such credits had been counted as covered earnings; (2) quinquennial adjustments to the pre-1957 portion of the 1983 lump-sum transfer; (3) general fund transfers equivalent to HI taxes on military deemed wage credits for 1984 and later, to be credited to the fund on July 1 of each year; and (4) adjustments as deemed necessary to any previously transferred amounts representing HI taxes on military deemed wage credits.

Automatic reinsurance plan wherein the assuming company reinsures a given percentage of certain types of risk that are insured by the ceding company.