Required criteria that insurance policies contain basic easy-to-understand English so that the average consumer can comprehend the meaning. A formula is used to determine the level of readability.

Review of patients readmitted to a hospital within 7 days with problems related to the first admission, to determine whether the first discharge was premature and/or the second admission is medically necessary.

1. Insurance claim processing that occurs immediately as opposed to batch processing (e.g., electronic claims transmission). 2. Immediate imaging to show movements.

Difference between the percentage increases before rounding in the average annual wage in covered employment and the average annual consumer price index (CPI).

In workers’ compensation cases, any job adjustment or work environment modification that assists a disabled employee to perform essential job duties.

Actual dollar amount of providing medical services or hospital services including direct and indirect costs to Medicare patients. Fiscal intermediaries and insurance carriers use the Centers for Medicare and Medicaid Services (CMS) guidelines to determine reasonable costs incurred by individual providers in furnishing covered services to enrollees.