Type
Crossword
Description

federal health insurance plan primarily for seniors medicare
setting for inpatient care hospital
federal law requiring employer to permit employees to continue their group health insurance coverage after termination cobra
conducting ourselves ethically and within the law of business practice compliance
collection and storage on patient demographic, insurance and clinical data registration
official count/list of patient population census
document verifying patient name identification
portion of bill that beneficiary must pay once insurance benefits have begun copay
a practice to reduce anxiety aidet
joint federal and state program to provide medical insurance for the poor medicaid
having a short, relatively severe course acute
not to be disclosed confidential
making an appointment scheduling
ambulatory patient outpatient
admitted for multi-day stay inpatient
healthcare consumer patient
ABN Advance _______ notice beneficiary
MSP Medicare ________ payor secondary
EMTALA Emergency Medical Treatment and ______ Act labor

PATIENT ACCESS Crossword

Type
Crossword
Description

Health Maintenance Organization; A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO
Fixed sum of money that beneficiary must contribute towards the cost of their healthcare before insurance benefits begin DEDUCTIBLE
Official count/list of patient population CENSUS
Not to be disclosed CONFIDENTIAL
Federal health insurance plan primarily for seniors MEDICARE
The administrative branch within the Department of Health and Human Services that is responsible for Medicare and Medicaid Services CMS
ost sharing in which the subscriber is responsible for a specific percentage of the cost of healthcare COINSURANCE
Person who is the holder of an insurance policy SUBSCRIBER
Questionnaire to determine primary payor before Medicare MSP
ederal law requiring employers to permit employees to continue their group health insurance coverage after termination COBRA
A fixed payment for a covered service COPAY
Preferred Provider Organization PPO
oint federal and state program to provide Medical insurance for the poor MEDICAID
Collection and storage on patient demographic, insurance, and clinical data REGISTRATION

Hospital Billing Crossword

Type
Crossword
Description

National Provider Identification NPI
The note received from the insurance company after getting medical services from a doctor or hospital. It tells what was billed, the payment amount approved or denied by the insurance, the amount paid, and what the patient must pay. EOB
Portion of the bill, as defined by the insurance company which the patient owes. Deductible
Advanced Beneficiary Notice ABN
A person or persons whose account that has been sent to a collection agency for further action. Bad Debt
The cost sharing part of the bill that the patients have to pay. Coinsurance
A part of the bill that we must write off because of billing agreements with insurance companies. Contractual Adjustment
A cost sharing part of the bill that is the patient’s responsibility to pay. Copay
A coding system used to describe what treatment or services were given to the patient by their provider. Used for hospital outpatient services billed on an UB and professional services billed on HCFA 1500s CPT code
How much cost sharing that the patient must pay for medical services often before their insurance starts to pay. Deductible
A code used for billing that describes the patient’s condition. Also called ICD-10 diagnosis code. Diagnosis code
Individual who is responsibility for the bill. Guarantor
Patient class in which the patient requires a higher degree of nursing and physician care. Inpatient
A person who is a policyholder of the insurance. Also known as the subscriber, policyholder, cardholder, or beneficiary. Insured
Type of service used by doctors and hospitals to decide whether a patient needs inpatient hospital care or whether they can recover at home or in an outpatient area. Usually charged by the hour. Observation
Any service received at a hospital or clinic that is not an inpatient status. Includes Emergence Room, Observation, and ancillary services. Outpatient
A form used by hospitals to file insurance claims for medical services. Used when billing for hospital technical services. UB
Part of medicare that helps pay for doctor services, outpatient care, and other medical services not paid for by Medicare Part A. Part B
Part of Medicare that usually referred to as Hospital Insurance, it helps pay for inpatient care in hospitals and hospices, as well as some skilled nursing costs. Part A
Claim form used by doctors to file insurance claims for medical services. Used when billing for professional services. HCFA
Medicare Secondary Questionnaire MSP
Hospital Billing (abv) HB
Professional Billing (abv) PB
After a patient is discharged from, the account status is changes from Open to DNB
Hospital Account HAR
A holding tank for accounts that we have identified has issues or needs follow up performed Workqueues
Hospital Clinic System used by WVUH EPIC

Patient Access Crossword

Type
Crossword
Description

Federal law requiring employers to permit employees to continue their group health insurance coverage after termination COBRA
Person who is the holder of an insurance policy INSURED
Who rocks I DO
Best boss ever Schenekia
Conducting ourselves ethically and within the law of business practices COMPLIANCE
Health Insurance ___ and Accountability Act PORTABILITY
Questionnaire to determine primary payor before Medicare MSPQ
Health Information (PHI - protected by HIPAA) PERSONAL
Payment for insurance coverage PREMIUM
Not to be disclosed CONFIDENTIAL
Patient Access Services PAS
Joint Commission on __ of Healthcare Organizations ACCREDITATION
Master____ Schedule Daily
Type of flower DAISY
Avid Coke drinker Courtney
Very knowledgeable Ayanna
Sinus problems Felicia
Out____ Crew STANDING

Medicare Crossword

Type
Crossword
Description

A federal health insurance program for people over 65, disabled or have End State Renal Disease Medicare
Covers inpatient care in hospitals, skilled nursing facilities and some hospice and home health Part A
Covers doctors services, outpatient care, PT/OT and some home health. PART B
Allows private health insurance companies to provide Medicare benefits through HMO's & PPO's Part C
_________________ Plans take the place of original Mediare. Advantage
coverage that helps lower prescription drug costs Part D
Beneficiary's Policy number HICN
Beginning _____ 2018, we will see new cards without SSN's April
Includes individuals enrolled in Medicare A&B and Medicaid Dual Eligibility
Dual eligible patients are 65 year old or disabled and ______________ Low Income
__________ Covers all or part of Medicare co-pays, co-insurance and deductibles for those with dual eligibility Medicaid
When Medicare does not have primary payment responsibility it is known as Medicare ________ payer. Secondary
End Stage Renal Disease ESRD
Group Health Plan GHP

Patient Access Week Crossword

Type
Crossword
Description

Meeting where coworker issues are resolved Huddle
Federal law requiring employers to permit employees to continue their group health insurance coverage after termination COBRA
Health Insurance _____________and Accountability Act Portability
Cost sharing in which the subscriber is responsible for a specific percentage of the cost of healthcare CoInsurance
(2 words) Tool that utilizes fee schedules, payer contracts, and benefits to calculate a cost estimate Price Estimator
(3 words) A Mercy program where the patient can receive a reduction in total costs as long as the account is over 45 days old Tax Discount Program
An insurance coverage that doesn't require authorization Medicare
Fixed sum of money that the beneficiary must contribute towards the cost of their healthcare before insurance benefits begin Deductible
The person who is financially responsible for the account Guarantor
Questionnaire to determine primary payor before Medicare MSPQ

Health Insurance Crossword Puzzle

Type
Crossword
Description

What does the acronym PPO stand for? Preferred Provider Organization
What is the acronym for Health Maintenance Organization? HMO
There are two types of medical billing: Institutional and _______________________. Professional
An __________ is a statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf. EOB
What type of claim form is used by hospitals? UB-04
Another name for a Health Information Specialist is a _________________________ Specialist. Reimbursement
An _____________________________ is a digital version of the traditional paper-based medical record for an individual. The EMR represents a medical record within a single facility, such as a doctor's office or a clinic. EMR
What is the amount you pay for health care services before your health insurance begins to pay? Deductible
A __________ is a fixed amount you pay for a health care service? Copay
A primary care physician is also known as a _______________________. Gatekeeper
What is the abbreviation for out-of-network? OON
What is the abbreviation for in-network? INN
What type of managed care plan lets you choose between an HMO or a PPO each time you need care? POS
How many parts does Medicare have? Four
A 1996 federal law that is sometimes called the "privacy rule", outlining how certain entities can use or disclose personal health information. HIPAA
The reason for the visit or surgery that defines the disease process or injury. Medical Necessity
M48.1 is an example of what type of code? ICD-10
What does UB stand for in UB-04? Uniform Bill
The healthcare system, funded by the U.S. Department of Defense, that active and retired military and their dependents use. Tricare
The entity that reimburses the provider for services. Insurance companies, Medicare, Medicaid, and third-party administrators are all payers in the healthcare industry. Payer
Any health care plan, provider, or service that transmits health care information in an electronic form and is thereby governed by laws and regulations in the handling of such data. It's called a covered _______________? Entity

Insurance Billing/Terminology Crossword

Type
Crossword
Description

The process of establishing the need for a service? medical necessity
A provider's list of charges for services provided. fee schedule
The amount the insurance company determines to be customary price for a service, usually less that what the provider charges? allowed amount
Fixed percentages of the cost of a service paid by the patient or a second insurance? coinsurance
Fixed amount paid by the patient at the time of service? copayment
Payment for health insurance policy? premium
A complete correct claim or a claim with no errors? clean claim
The primary provider who arranges for specialists or hospitalizations? gatekeeper
The medical insurance policy that is billed first? primary policy
National Provider Identification NPI
Centers for Medicare and Medicaid Services CMS
Managed Care Organization MCO
Diagnosis Related Group DRG
Medigap MG
Advance Beneficiary Notice ABN
Coordination of Benefits COB
Primary Care Provider PCP
Fee-For-Service FFS
Common for insurance to require approval for? elective procedures
Used to identify a procedure on a claim form? CPT
Family members of the insured are called? dependents

MEDICARE WORD SEARCH PUZZLE

Type
Word Search
Description

INSURANCE
MEDICARE
CREDITABLE COVERAGE
PENALTY
MEDIGAP
BENEFICIARY
BRAND NAME
GENERIC
DONUT HOLE
OUTPATIENT
HOSPITALIZATION
PRESCRIPTIONS
ANNUAL ENROLLMENT
ADVANTAGE
SUPPLEMENT
COPAY
PREMIUM
DEDUCTIBLE
PART B
PART A

Healthcare Vocabulary Crossword

Type
Crossword
Description

A contract with a company where the subscriber pays a regular premium in exchange for a defined set of benefits Health Insurance
Reffered to as family doctor/PCP this person administers routine and preventive care, and makes referrals for specialty services when needed. Primary Care Provider
A provider who focuses on one area of medicine. Like a cardiologist or neurologist Specialist
A contracted, pre-determined dollar amount insurance company requires a patient to pay for a particular medical service. (It requires patients to pay a small amount upfront to deter people from seeking medical care that may not be necessary.) Copay
The contracted rate a health insurance company will pay toward a specific medical service. Allowable Charges
A contracted, pre-determined percentage of the allowable charge that a patient is required to pay for a particular medical service (after the deductible is met and before the out-of-pocket maximum is met). CoInsurance
A pre-determined annual amount patient must pay before insurance begins to cover. Deductible
Annual maximum amount patient is required to pay for in-network medical services per his/her insurance plan contract (typically, copay + coins + deductible) Out of Pocket
The person who is responsible for payment of the monthly premium, or whose employment is the basis for the coverage. Subscriber
A person entitled to health insurance benefits under the subscriber’s plan. Covered Member
Insurance Company Payor
A specific package of benefits negotiated between the company and the employer. Plan
Dates during which the insurance plan is active. Effective Dates
Explanation of Benefits is a statement from the insurance company that details payments and adjustments made for services. EOBs go to both the provider and the patient. EOB
/Response from the insurance company that states no payment will be made. (service could be not covered by the insurance plan, or the insurance company may need more information.) Denial
The order in which the claim is sent to insurance companies. If patient has more than one insurance plan, we must determine which insurance should be billed primary, secondary, etc. Primary: the first insurance company designated to pay toward their allowable charges. Secondary: the second insurance company designated to pay toward their allowable charges. Filing Order
The pathway a patient takes from one provider to another. Referrals may be required by insurance before a patient can be seen by the other provider. Referral
The process whereby a physician must obtain insurance approval before a patient receives certain treatment or drugs (study, test, procedure, surgery.) Authorization

Basics of Health Insurance Crossword

Type
Crossword
Description

An established schedule of fees set for services performed by providers and paid by the patient fee for service
protection in return for periodic premium payments that provides reimbursement of expenses resulting from illness or injury Health insurance
the sum of money paid at the time of medical service; it is a form of coinsurance copayment
provision frequently is found in medical insurance policies whereby the policyholder and the insurance company share the cost of covered losses in a specified ratio coinsurance
Civilian Health and Medical Program of the Veterans Administration known as CHAMPUS
states that when an individual is covered under two insurance policies, the insurance plan of the policyholder whose birthday comes first in the calendar year (month and day, not year) becomes the primary insurance. birthday rule
A term used in managed care for an approved referral authorization
a payment method used by many managed care organizations in which a fixed amount of money is reimbursed to the provider for patients enrolled during a specific period of time, no matter what services were received or how many visits were made. Capitation
a letter or statement from Medicare that describes what was paid, denied, or reduced in payment. EOMB
Pays expenses involved in the care of the teeth and gums Dental care
Protects a person in the event of a certain type of accident, such as an airplane crash Special risk insurance
Often includes benefits for medical expenses payable to individuals who are injured in the insured person’s home or during an automobile accident Liability insurance
Covers a continuum of maintenance and health services for chronically ill, disabled, or mentally retarded individuals Vision care
Provides payment of a specified amount on the insured’s death Life insurance
Pays the cost of all or part of the insured person’s hospital room and board and specific hospital services Hospitalization
a review of individual cases by a committee to make sure services are medically necessary and to study how providers use medical care resources utilization review
40. An insurance term used when a primary care provider wants to send a patient to a specialist referral
periodic (monthly, quarterly, or annual) payment of a specific sum of money to an insurance company for which the insurer, in return, agrees to provide certain benefits premium
person who pays a premium to an insurance company and in whose name the policy is written in exchange for the insurance protection provided by a policy of insurance policyholder
a general practice or nonspecialist provider or physician responsible for the care of a patient for some health maintenance organizations gatekeeper