MEDICAL,USA: Act of modifying an insurance policy’s benefits because of some type of change (e.g., insured’s occupation).
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The adjustment of the benefits paid by reason of change of occupation or the existence of other Insurance covering the same accident or disability.
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The modification of policy benefits because of a change in the insured person’s occupation or the existence of other insurance.

Good and bad parts of treatment for a health problem (e.g., a medicine may help the patient’s pain [pro], but it may cause an upset stomach [con]).

To submit a charging document to a court; seek a grand jury indictment against person(s) accused of committing criminal offenses.

Federal commission that was replaced by the Medicare Payment Advisory Commission (MedPAC). See Medicare Payment Advisory Commission (MedPAC or MedPac).

Method of payment mandated by the Balanced Budget Act of 1997 (BBA) that changed Medicare hospital payments from cost based to prospective, based on national average capital costs per case. Examples of PPS include Medicare’s physician fee schedule and for inpatient diagnosis-related groups (DRGs) that set a predetermined, fixed dollar amount for a principal diagnosis. PPS helps Medicare control its spending by encouraging providers to furnish care that is efficient, appropriate, and typical of practice expenses for providers. Patients and resource needs are statistically grouped, and the system is adjusted for patient characteristics that affect the cost of providing care. A unit of service is then established, with a fixed, predetermined amount for payment. Sometimes called prospective reimbursement. Also see outpatient prospective payment system (OPPS).

To set a price before rendering a service (e.g., the Medicare prospective payment system [PPS]). The opposite of this would be the reimbursement system in which the medical service is given first and then the provider of the service receives payment.

MEDICAL,USA: 1. To find out a future property or liability insurance rate. 2. Premium for a certain projected period of time based on the loss experience of a specific prior period of time. In such a contract, the carrier assumes the risk (inadequate or excessive) and the purchaser pays a fixed rate for the contract period. Other factors may be considered in adjusting the rates for renewal of insurance such as insurance industry trends or inflation.
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A method used in arriving at the rate and premium for a specified future period, based in whole or in part on the loss experience of a prior specified period.
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A way of calculating the rates or premiums for a particular period in the future. This method is based on the losses sustained during a particular period in the past.
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REINSURANCE,REFERENCE: See: Rating

1. Process of going over financial documents before billing is submitted to the insurance company to determine documentation deficiencies and errors. 2. Method of evaluating a case before admission to find out if hospitalization is necessary, the estimated length of stay, or alternate outpatient treatment.