Type of hospital invoice (patient’s financial accounting statement) assessed by someone auditing a hospital bill that has services that have been provided and not billed. Also see clean bill and over bill .

Uncoded or undercoded services and procedures that are due to poor medical documentation and not enough information in the patients’ medical records to code at levels of full payment.

Medical training provided to students in medical school.

Individual whose insurance policies do not cover all necessary health care services and he or she cannot pay the entire balance due.

Under Medicare Secondary Payer guidelines, this is described as an optional liability insurance available in some regions under which the policyholder’s level of protection against losses caused by another is extended to compensate for inadequate coverage in the other party’s policy.

Third-party payment paid to the provider at less than negotiated contract rate.

Act of a provider withholding necessary medical services because of cost constraints.

Section in an insurance company that chooses the risks that the company will insure and verifies that the mortality and morbidity rates of the company’s insureds do not exceed the rates adopted when premium rates were calculated. This division also negotiates and manages reinsurance agreements. Also called the new business department .

Profit that remains as a surplus of health insurance premium income over claims and administrative expenses.