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To look up a health care term such as Actuary, choose the letter that the term begins with below under Alphabetical Glossary. This will take you to the terms beginning with that letter. To look up a health care acronym such as AIDS, choose the letter that the term begins with below under Acronyms. This will take you to all acronyms that begin with that letter.

Race To The Bottom	Process in which health plans in a highly competitive market reduce the scope of their benefit packages in order to offer lower premiums. Competitors must follow suit or risk attracting sicker enrollees. Also see adverse selection.
Rate Cell	Amount paid for an individual's care in a Medicare HMObased on the relevant adjusted average per capita cost. Also see adjusted average per capita cost.
Rate-Setting	The determination by a government body of rates a health care provider may charge private pay patients.
Rating	The process of determining rates for insurance policies or health contracts for individuals, groups, or classes of risks.
Rating Bands	Limits on how much an insurer can vary health insurance premiums to different groups for the same insurance plan.
Reasonable and Customary Fee	A reasonable charge is a charge that, in the context of the community is fair. A customary charge is a charge or fee that falls within the customary range of charges or fees prevailing in a specific geographic area for the provision of a similar service, procedure, or supply.
Recidivism	The frequency of the same patient returning to a provider with the same presenting problems. Usually refers to recurring inpatient hospital services.
Recipient	A person who receives a Medicaid service while eligible for the Medicaid program. Individuals may be Medicaid eligible without being Medicaid recipients. Also see Medicaid.
Reciprocity	The right of an enrollee in a health plan who is temporarily away from home to receive necessary medical care under the arrangements of a health plan in the area in which the enrollee receives medical care.
Reconsideration	Review of an adverse coverage determination that may be requested by the patient or representative, the attending physician, or the hospital. Reconsideration is performed by the original reviewing body, not by an independent appeals panel.
Redlining	An insurance practice used to exclude entire occupations, businesses, geographic areas, and age groups from health insurance coverage to limit loss.
Referral	The recommendation by a physician and/or health plan for a member to receive care from a different physician or facility.
Refined Diagnosis Related Group (RDRG)	An expanded list of diagnosis related groups to take into account a patient's severity of illness.
Registered Nurse (RN)	An individual who provides nursing services after completing a course of study that results in a baccalaureate degree and who has been legally authorized or registered to practice as an RN and use the RN designation after passing examination by a state board of nurse examiners or similar state authority.
Registered Respiratory Therapist	Aids in the treatment of patients with serious respiratory problems and heart and lung disorders. The therapist assists with long term venilation procedures, administers breathing treatments and maintains respiratory equipment.
Regulation	An authoritative rule having the force of law dealing with details or procedures for implementing governmental programs. Regulations are issued by executive authority of the Federal or state government. Also see statute.
Rehabilitation	To restore health following an accident, injury or illness.  Acute Rehabilitation: Early rehabilitation phase as soon as medically stable. Primary emphasis is to provide intensive physical and cognitive restorative services in the early months following injury. Typical stay 3-4 months (short term). Based in medical facility. Sub-Acute Rehabilitation: Post-acute phase of rehabilitation. Capacity to treat for 6-24 months. Need not be hospital based. Stay based on demonstrated improvement. Transitional Rehabilitation: To prepare for community re-entry. Non-medically based. Emphasis on functional skills for maximum independence. May be in group home or part of a continuum of rehabilitation center. Typical stay 4-8 months. Greater focus on compensation vs. restoration. Long Term Rehabilitation Program: May be called Extended Rehabilitation. Have full range of rehabilitation services available. Frequently after initial year of rehabilitation when progress is slower. Generally not permanent placement. May be facility or community based. Rehabilitative (restorative) Care: Skilled care provided by a trained medical person (physical therapist, R.M., speech therapist).
Reinstated Benefits	When a policy has lapsed due to nonpayment of premiums, benefits may be reinstated at the company's option. It is common for the company to determine proof of insurability before it will do so.
Reinsurance	A mechanism to protect against part or all of the financial losses that may be incurred through insuring for risk. Reinsurance may be used for property and casualty losses as well as for life and health claims. It is a common "stop-loss" mechanism used by self-insured and insured entities throughout the economy, including business and industry, labor organizations, hospitals, HMOs, individual professionals, and even insurance companies. It is commercially available from insurance underwriters. It is also referred to as "risk control insurance." The coverage may be uniquely written for an individual claimant or groups of claimants.
Relative Value Scale (RVS)	An approach to physician reimbursement based upon the time, effort, and skill each service or procedure requires from a physician when compared with other medical services or procedures.
Renewable at the Option of the Insurance Company	This refers to policy contract renewability. The insurance company can choose to cancel the policy on an individual basis.
Renewal	Continuance of coverage under a policy beyond its original term by the acceptance of a premium for a new policy term.
Renewability	Guarantee that coverage cannot be discontinued as long as the insurer continues to do business in that particular market. However, the premium that can be charged is not necessarily protected.
Report Cards	Information on health plan performance presented in a consumer friendly manner to facilitate cross-plan comparisons.
Required Request	A system enacted by state lawmakers in 1987 requiring hospitals to request organs from a deceased's family when the deceased is determined to be medically suitable.
Reserves	Monies earmarked to cover anticipated claims and operating expenses for a set period of time. Reserves are an obligated amount and have three principal components: reserves for known liabilities not yet paid; reserves for losses incurred but unreported; and other reserves for various special purposes, including contingency reserves for unforeseen circumstances.
Resident	(1) A physician in training after medical school graduation. In the modern era, specialties require at least three years of residency training. Many specialties require four years or more, and it is not uncommon for physicians to undertake fellowships for further specialty training after a residency. Also see intern. (2) An individual in a nursing home, assisted living or other residential facility.
Resident Assessment Instrument (RAI)	See minimum data set, or resource utilization groups.
Resident Assessment Protocols (RAPs)	Process used to assess nursing home residents who have problems (such as incontinence, or dementia) that have an especially significant impact on their care. Also see minimum data set, or resource utilization groups.
Resource-Based Relative Value Scale (RBRVS)	Medicare fee schedule for physician services that set a uniform payment in each geographic area for most of the approximately 7,000 medical procedures.
Resource Conservation and Recovery Act (RCRA)	RCRA was put into place to protect human health and the environment by regulating the management of hazardous waste and its disposal. Regulates and monitors the generation, storage, treatment and disposal of hazardous waste and is listed in 40 Codes of Federal Regulations (CFR), part 261.
Resource Utilization Groups (RUGS III)	Patient classification system for nursing home patients used by the Federal government and some states to determine reimbursement levels for nursing home care. Also see minimum data set.
Respiratory Therapy Technician (Uncertified)	Administers treatments to patients by performing arteriopunctures, analyzes blood by utilizing blood gas analyzers. Sets up and operates various types of oxygen and other therapeutic gasses.
Respiratory Therapy Technician Certified (CRTT)	Performs duties as described in Respiratory Therapy Technician, but has an associate degree in respiratory therapy and has successfully completed the certification exam.
Respite Care	Short term care which is needed in order to maintain health or safety and provides temporary relief from care-giving duties to a member of the immediate family (or any other unpaid, primary caregiver). Respite care can include such services as home care, home health care, adult day care and institutional care.
Rest Residential Care	Residential option providing less care than assisted living, usually at the "board and care" level (i.e. no direct health or personal care services) provided in a congregate facility. Also see family rest residential care, foster care, and board and care.
Restoration of Benefits	Provision of some LTC policies stating that once an individual is benefit-free for a specified length of time, usually six months, those benefits already paid out are restored.
Retention	Insurance carrier's provision in experience rating for taxes, cost for the assumption of risk, benefit plan administration, maintaining reserves, other expenses and contributions to the return on equity of the insurance company.
Retroactive Review	See retrospective review.
Retrospective Review	A manner of judging medical necessity and appropriate billing practices for services that have already been rendered.
Return of Premium Benefit	A type of non-forfeiture benefit included in some long-term care policies that provides a cash value accumulation and return of premiums in the future to enrollees who receive no policy benefits or minimal benefits while the policy is in force. Exact provisions vary from policy to policy, but generally provide a greater return the longer the policy is in force and usually deduct the amount of any claims paid before returning premiums to the enrollee.
Review, Concurrent	Assessment of a patient's need for inpatient hospital services at admission and at specified intervals throughout the inpatient stay, using objective criteria to determine the medical necessity of acute inpatient care. Includes admission review, continued stay review, and utilization review.
Review, Peer	An examination by practicing physicians or other health professionals of the medical necessity, appropriateness, and quality of the health care services ordered or provided by other physicians or other health professionals. The efficiency and effectiveness of the patient care services are also reviewed. It may be conducted while the patient is in the hospital (concurrent review) or after discharge (retrospective review).
Review, Private	Review of patient care episodes to ensure the medical necessity and appropriateness of services and charges, usually for services financed through institutional purchaser health benefit programs. Private review services are offered by many entities, including insurance companies and their subsidiary companies specializing in managed care services, hospitals, and foundations for medical care. Peer review organizations (PRO), Federally authorized agencies, sell review services to private sector purchasers of health care. There are currently no licensure or certification standards for private review programs. Private review is usually implemented through a contractual relationship between the purchaser and the reviewing entity; it may also be financed on a fee per review, an annual fee based upon the number of covered individuals, or percentage of the annual premium or expenditure, or some combination, and may include a performance incentive bonus relating the costs of conducting the review services, the projected health plan expenditures, and actual savings.
Review, Utilization	See utilization review.
Rider	A legal document that modifies a health care services contract or insurance policy, either expanding, decreasing or otherwise revising the coverage to be provided. Also referred to as amendments or endorsements.
Risk	The chance or possibility of loss, often employed as a utilization control mechanism within an HMO setting. Risk is also defined in insurance terms as the possibility of loss associated with a given population.
Risk Adjuster	A measure used to adjust payments made to a health plan on behalf of a group of enrollees in order to compensate for spending that is expected to be lower or higher than average, based on the health status or demographics of the enrollees.
Risk Adjustment	Enhanced capitated rate based on mitigating factors such as presence of certain conditions in a sub-population.
Risk Agreement	Term used in the disability community to refer to a signed document by both an individual and a services provider that details the tasks that will be the responsibility of each party. In particular it refers to those services that the consumer does not choose to accept even though the service provider believes they are necessary.
Risk Analysis	The process of evaluating the expected medical costs for a prospective group and determining what product, benefit level and price to offer in order to best meet the needs of the group and the carrier.
Risk Assessment	Anticipating the cost of providing health care to groups of enrollees. Actuarial assessments examine utilization history, demographics, health characteristics, environmental attributes, and other sociological, economic and market characteristics.
Risk-Bearing Entity	An organization that assumes financial responsibility for the provision of a defined set of benefits by accepting prepayment for some or all of the cost of care. A risk-bearing entity could be an insurer, a health plan, a self-funded employer or a provider sponsored network, for example.
Risk Contract	A legal agreement between a payer and provider to share in either the net revenues after expenses or financial losses incurred as a result of providing health care services within a defined delivery system, such as anHMO or PPO. A percentage of provider or professional payments that are withheld by the payer to satisfy the risk provisions at the end of the fiscal period.
Risk Control Insurance	The acceptance by one or more insurers of a portion of the risk underwritten by another insurer who has contracted for the entire coverage. It is also called reinsurance or stop-loss insurance.
Risk Corridor	Form of risk sharing where loss or profit is limited to a small percentage of the break even point to prevent excessive profiteering or catastrophic losses to a risk bearer such as a managed care organization. Often used by public payers such as state governments in Medicaid managed care plans.
Risk Factors	Conditions that influence a person's health status and are capable of causing illness or injury, including genetic or biological risk factors, life style, or environmental conditions.
Risk Load	A factor that is multiplied into the rate to offset some adverse characteristic of the group.
Risk Pool	A distinct population group, such as employees of a company, insured against costs of their potential use of health care resources. Premium projections are based on variables such as the age of the covered population, health status, sex, occupation, group size, and location. Structure can provide positive incentives to the participants, such as sharing savings when expenses are below projections; sharing losses when actual expenses exceed budgeted expenses, or a combination of these. May also describe a financial arrangement among providers and payers to safeguard against unexpectedly high expenses or utilization.
Risk Pools, Medically Uninsurable	To facilitate access to health care services for individuals with health risks that are considered medically uninsurable, some states are creating risk pools though legislation. These are funded though a variety of mechanisms, including a premium tax on commercial insurance policies, payroll taxes, general revenues, or a combination of these approaches. Premiums for policies are usually 150% or more of the generally available insurance premium to avoid disrupting the insurance market.
Risk Pools, Residual Risk	Small groups that include individuals with known health conditions requiring medical services are considered to be high risk and have premiums that are higher than average for groups of comparable size. Creating a larger pool by merging these groups to spread the risk across a larger base or to seek relief through government-sponsored and funded risk pools are two approaches under consideration to contain the premium costs for residual risk groups.
Risk Product	Insurance plan involving partial or full risk.
Risk Segmentation	Disproportionate numbers of persons with higher than average risk of health problems being concentrated in particular risk pools. Also see adverse selection.
Risk Selection	Any situation in which health plans differ in the health risk associated with their enrollees because of enrollment choices made by the plans or enrollees. That is, where one health plan's expected costs differ from another's due to underlying differences in their enrolled populations.
Risk Sharing	Sharing the opportunity for reward or loss.
Risk Withhold	See withhold.
Robert Wood Johnson Foundation (RWJ)	Largest and most important U.S. philanthropic organization concerned with health care issues. Also see center for health care strategies.
Room and Board	See board and care.
Routine Notification	A system being proposed at the state and national levels requiring hospitals to call a regional telephone number when death is imminent to determine if organs are suitable for transplant.