Tag: Medical policy

The use of the term 'provider' to refer to physicians and other medical professionals became prominent in the United States during the late 20th century, particularly influenced by insurance and governmental language. This terminology shift raises questions about its origins, including: **When did we start calling doctors providers?**

In the complex world of healthcare, a drug's approval for certain uses is a critical factor for insurance coverage. The Centers for Medicare & Medicaid Services (CMS) defines rules around this concept, making the meaning of **medically accepted indication** crucial for both patients and providers.

The vast majority of healthcare claims are adjudicated based on one fundamental principle: medical necessity. Understanding which of the following establishes medical necessity for treatment provided is critical for patients, providers, and insurers alike to ensure treatments are appropriate, effective, and covered.