Method that sets the payment rate for hospital services after services have been provided.
Tag: RAW
Retrospective review
1. In external auditing, process of going over financial documents after billing an insurance carrier to determine documentation deficiencies and errors. Also called retrospective payment audit . 2. In utilization review, evaluation of medical services given to a patient to make sure the insurance claims are paid for appropriate care (i.e., medical necessity, quality of care, physicians’ practice patterns, hospitals’ average length of stay, and reasonableness of services given).
Retrosurance
There is said to be retrosurance when, after reinsurer A has retroceded all or part of his risk to reinsurer B, reinsurer B then further cedes all or part of his risk to a third reinsurer.
Return Commission
A commission paid by a reinsurer to the ceding company for proportional reinsurance business to recompense the cedant for acquisition expenses.
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A situation that may happen in the case of a policy that pays a commission based on the full yearly premium. If the policy is cancelled before the entire premium is earned, a portion of the commission must be returned.
Return for layup and cancellation for Marine Hull
No return of premium is payable once the risk has attached, unless the underwriters avoids the contract through breach of warranty and there has been no fraud on the part of the insured. However, in a time policy on hull, it is equitable that there should be a return of premium when the risk is reduced by cancellation of part of the insured period or when a vessel is laid up in a port where it is not subject to so many perils. Cancellations for reasons other than sale or transfer are provided for in returns clause, where the return allowed is only in respect of each uncommented month that the policy is cancelled. The presence of cargo on board the vessel or loading or unloading operations shall not debar returns. However, no returns will be allowed for any period while the vessel is being used for storage of cargo or for lightering purposes.
Return for No Claim
A provision found in some policies that if no claim is made under an insurance, the insurer will return part of the premium.
Return of cash value (Life Insurance)
A provision within a life insurance policy stating that should the insured die within a certain named period, the policy will pay the face amount plus the cash value of the policy on the date of the insured’s death.
Return of premium (Health Insurance)
A clause stating that a benefit equaling the amount paid in all premiums will be paid, minus any amounts paid out in claims, if the claims made in a particular time frame do not exceed a certain percentage of the premiums paid.
Return of service
See: proof of service .
Return on Policyholder Surplus (Return on Equity)
The sum of after-tax net income and unrealized capital gains, to the man of prior and current year end policyholder surplus, expressed as a percent. This ratio measures a company’s overall after-tax profitability from underwriting and investment activity.