Disenrollment from a health insurance plan expressed as a percentage of total membership. For example, a managed care plan with 40,000 members with a 2% attrition rate would need to gain 800 new members each month to retain the initial 40,000 covered lives.
Insurance Encyclopedia
Attritional loss ratio
The measure of residual insurance claims as a percentage of earned premiums (net of reinsurance). Attritional insurance claims are calculated as total claims with major losses and movements in prior year claims reserves subtracted.
AU
HCPCS Level II modifier that may be used with CPT or HCPCS Level II codes indicating item(s) used with urological, ostomy, or tracheostomy supplies. Use of this modifier affects Medicare payment.
Audit
1. Formal, methodical examination or review done to inspect, analyze, and scrutinize the way something is being done (e.g., bookkeeping practices, medical record documentation, insurance claim filing) to determine operational efficiency. 2. In the Medicare program, a process to ensure that the fiscal intermediary reimburses providers based only on costs associated with patient care.
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Some policies (such as workers compensation) are written subject to an audit. Since workers compensation premium is based on the insured’s payroll, the insurer is entitled to audit the insured’s records at the end of the policy to verify that it has collected an adequate premium for the amount of payroll to which it was exposed.
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US: A survey of the financial records of a person or organization conducted annually (in most cases) to determine exposures, limits, premiums, etc.
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Survey of an insured’s records to determine the premium which should be paid to the Insurer for protection furnished and perhaps for other purposes, such as compliance with loss control recommendations.
Audit by request
Type of audit of hospital patient records that occurs when a patient asks for an audit to verify hospital charges. Also see defense audit and random internal audit.
Audit Classification
A coding system for identifying the class of risk for entry in a return that has to be made to some designated office.
Audit Premium
The additional premium to which an insurer is entitled or the return premium to which the insured is entitled after an audit and refiguring of the base on which the original or deposit premium was charged.
Auditor
Individual who makes a formal examination and verification of records.
Auditors charges
See: Accountants’ Clause.
Augmentation
Add to or increase a body site (e.g., plastic reconstruction procedure, implant, prosthesis, bone or soft tissue graft).
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UK: Provision of additional benefits for particular members of an occupational pension scheme. The cost normally falls on the employer.