1. Groups of licensed physicians and osteopaths engaged in the practice of medicine or surgery in a particular area, formed to ensure adequate review of the services provided by the various medical specialties and subspecialties in the area, as well as providing DRG validation. 2. A group of physicians working with the government to review cases for hospital admission and discharge under government guidelines. Under the Medicare program, PROs are known as Quality Improvement Organization (QIO) programs. See also peer review and Quality Improvement Organization (QIO) program.
Insurance Encyclopedia
Professional sports teams exclusion
Cover in respect of professional sports teams is a standard exclusion in a personal accident catastrophe excess of loss reinsurance cover. The sums insured are high and there is an accumulation risk.
Professional Standards Review Organization (PSRO)
Replaced by Utilization and Quality Control Peer Review Organization (PRO) in 1982 and in 2003 called Quality Improvement Organization (QIO) program.
Profile
1. Compilation of financial data maintained by an insurance carrier for reimbursement purposes. Also see physician’s fee profile. 2. Data segregated by specific time period (e.g., quarterly, annually) and target area (e.g., facility or state) for the purpose of identifying patterns. This may include diagnoses, procedures, diagnosis-related groups, and so on.
Profile analysis
Examination and assessment of activities of patients and physicians to show trends and patterns of health care services.
Profile year
Twelve-month period that traditional indemnity insurance companies maintain to determine allowable charges.
Profiling
Evaluation of a physician’s practice that includes demographics of patients, morbidity data, mortality rates, and treatment patterns. Also called physician profiling.
Profit
Dollar amount that remains from a payment after all expenses for the service have been paid.
Profit and commissions insurance (Property Insurance)
A type of insurance for those whose income is dependent on commissions or profits tied to a certain property. This insurance covers loss of income due to damage done on the property the income depends on.
Profit commission
UK: A commission based upon a pre-defined formula intended as an incentive and reward. Examples are: (a) the commission received by an underwriting agent from the syndicate members at Lloyds as a reward for profits; (b) the commission received by a cedant from a reinsurer as a reward for the ceding of profitable business.
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REINSURANCE: A commission feature whereby the cedent is allowed a commission based on the profitability of the reinsurance contract after an allowance for the reinsurer’s expense and profit margin.
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A provision found in some reinsurance agreements that provides for profit sharing. Parties agree to a formula for calculating profit, an allowance for the reinsurer’s expenses, and the cedant’s share of such profit after expenses. See Adjustable Features, Risk Charge, and Experience Refund.
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UK: at Lloyd’s, remuneration received by an underwriting agent based on the results of a year’s underwriting (but see also contingent commission).
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REINSURANCE: Commission paid by a reinsurer to a ceding office under a proportional reinsurance treaty that is dependent upon the profitability of the total business ceded during each accounting period. Also used, in other arrangements, as any commission contingent on the claims experience.