Category: R

In the executive branch of the Federal Government, an agency statement of general or particular applicability and future effect designed to implement, interpret or prescribe law or policy, or describing the organization, procedure or practice requirements of an agency. Commonly also called a regulation. Rides are published in the Federal Register. The process of writing…

A list of patients served by a given health professional or program (whose roster it is). The roster ma}’ be derived from a registry or list of encounters but the listing of an individual on a roster does not necessarily imply any ongoing relationship between the program and the individual.  

The fraction of a premium which goes to generate or replenish surpluses which a carrier must develop to protect against the possibility of excessive losses under its policies. Profits, if any, on the sale of insurance are also taken from the surpluses developed using risk charges. The risk charge is sometimes referred to as the…

A legal document which modifies the protection of an insurance policy, either expanding or decreasing its benefits or adding or excluding certain conditions from the policy’s coverage.  

Payment to providers by a third party carrier for costs or charges actually incurred by subscribers in a previous time period. This is the method of payment used under Medicare and Medicaid.  

In malpractice, a form of vicarious liability whereby an employer is held liable for the wrongful acts of an employee even though the employer’s conduct is without fault. Before liability predicated on respondeat superior may be imposed upon an employer, it is necessary that a master/servant (i.e., controlling) relationship exist between the employer and employee…

Sources of support available to an individual in addition to his regular earned or unearned income. Generally resources refer to an individual’s wealth or property (including cash savings, stocks and bonds, a home, other real estate, the cash value of life insurance, an automobile or jewelry which could be converted to cash if necessary. Existing…

Balance sheet accounts set up to report the liabilities faced by an insurance company under outstanding insurance policies. Their purpose is to secure as true a picture as possible of the financial condition of the organization (by permitting conversion of disbursements from a paid to an accrual basis). The company sets the amount of reserves…

Conscious action to acquire deeper knowledge or new fact about scientific or technical subjects. Several different types are distinguished by their concern (such as biomedical and health services) or method. A scientific study which investigates something new. In medicine, the collation and assessment of existing facts and knowledge, and the critical systematic investigation of the…

In the Federal budget, enacted legislation cancelling budget authority previously provided by Congress. Rescissions proposed by the President must be transmitted in a special message to the Congress. Under section 1012 of the Congressional Budget and Impoundment Control Act of 1974, unless Congress approves a rescission bill within forty-five days of continuous session, the budget…