Nineteen criteria for admission under the prospective payment system, separated into two categories: severity of illness and intensity of illness. To allow a patient admission to an acute care facility, one criterion from each category must be met.
Tag: RAW
Appropriateness of care
See: appropriateness.
Appropriation
earmarking for the benefit of policyholders or shareholders what was formerly ascertained but unappropriated surplus.
Approval
See: preauthorization. Also See: precertification and predetermination.
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UK:
The granting of tax exempt status by the Inland Revenue Savings, Pensions and Share Schemes Office to pension arrangements that meet the legislative requirements. Members will then be able to set all or part of their pension contributions against their income tax liability. Schemes meeting certain conditions get mandatory (auto matic) approval while in other cases discretionary approval may be given. Most occupational schemes are exempt approved schemes.
Approval categories
Following changes made in 1987 and 1989 Inland Revenue approval of pension schemes falls into three different categories of membership: Class A; Class B; Class C. New schemes may only be approved under the 1989 rules following the Finance Act of that year.
Approval wire
Blue Cross and Blue Shield phrase that means the formal notice sent by a host plan from the home plan after the home plan has received the admission wire and verified membership information. This approval is given for a specific number of days and insurance contract benefits. See also admission wire.
Approved
A risk, individual, product or building that meets the Underwriting standards of the Company, Usually applied to construction, preventive and protective devices, packing goods etc. to indicate that they meet the requirements for Insurance, as for a reduced premium rate.
Approved alarm systems
Household contents insurers may give discounts to insureds who install and maintain an intruder alarm approved by NACOSS the National Approval Council for Security Systems. It is common practice in commercial policies to include an intruder alarm warranty requiring the installation and maintenance of a NACOSS approved alarm. The alarm system has to be kept in operation.
Approved amount
See: approved charge.
Approved charge
1. Maximum dollar value the commercial private insurance company or managed care contract assigns to each procedure or service on which payment is based. Typically, a percent (e.g., 80%) of the allowed amount is paid by the insurance carrier. 2. Allowed amount based on the Medicare fee schedule or its transition rules, which may or may not be the same as the actual amount billed. The patient may or may not be responsible for the difference. Nonparticipating physician charges are subject to the limiting charge. 3. Also called the allowed amount or approved amount. See also Medicare-approved amount, maximum allowable, and maximum allowable charge (MAC).
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Amounts paid under health insurance as the maximum fee for a covered service.