Type of managed care contract between Medicare and a payer or a payer and a provider wherein patients receive care during the entire term of the contract even if actual costs exceed the payment established by the agreement.

Age of the insured as of the insured’s last birthday.

Medical staff member who is legally and primarily responsible for the medical care and treatment given to a patient and who would normally be expected to certify and recertify the medical necessity of the number of services rendered for the patient’s care while in the hospital. An attending physician who has a patient admitted to the hospital may be referred to as the admitting physician.

Form that, when completed, provides the insurance company with information about the patient’s injury or illness, diagnosis, and treatment. An APS form is completed when the insurance company requests information to decide whether to insure an individual or, if insured, when settling an insurance claim.

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.