Type
Crossword
Description

Who is Home Services Vice President? Denise Schrader
What month does the Notice of Admission go into effect in 2022? January
P.A.M. generates self-pay monthly statements for home health and hospice. What does P.A.M. stand for? PatientAccountManagement
How many calendar days does a Notice of Election have to be received and processed at Medicare Five
What is the coding state of having multiple medical conditions at the same time, especially when they interact with each other. Comorbidity
What is the name of home health and hospice clearinghouse? Waystar
What is the name of the Home Health and Hospice EMR? MatrixCare
What is the patient's share of the costs for a covered health care service, calculated as a percentage? Coinsurance
What is the amount a patient pays for services received before their health plan begins to pay? Deductible
A fixed amount the patient pays for covered health care services, usually when the service is received. Copay

Medicare Terms Crossword

Type
Crossword
Description

means that your doctor, provider, or supplier must accept the Medicare-approved amount as full payment for covered services Assignment
this visit is available once every twelve months after the first twelve months of Part B coverage AnnualWellnessVisit
the percentage you pay for covered services after you have met your deductible Coinsurance
a fixed amount one pays to receive a medical service, usually at the time of service Copay
the amount one pays annually before the plan begins to pay. This does not apply to services that require a copay Deductible
is long lasting, used for a medical reason, and typically used in an individual's home DME
ESRD EndStageRenalDisease
the plan contract that gives detailed information about the plan, including: what is and is not covered, what an individual pays, etc. EOC
a monthly summary sent to an individual to let them know what services were billed, what was paid by whom, and what amount the individual is responsible to pay. EOB
in this type of plan you can only go to doctors, other health care providers, or hospitals in the plan’s network except in an urgent or emergency situation. HMO
care that is usually given when an individual has decided that they no longer want care to cure terminal illness and/or one’s doctor has determined that efforts to cure an illness aren’t working. Hospice
a status for individuals starting when one is formally admitted to a hospital with a doctor’s order Inpatient
a status for individuals getting emergency department services, observation services, surgery, lab tests, X-rays, or any other hospital services, and the doctor hasn’t written an order to admit them to a hospital as an inpatient Outpatient
in a PPO, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network PPO
the periodic payment to Medicare, an insurance company, or a health care plan for health or prescription drug coverage Premium
services to prevent illness or detect illness at an early stage Preventive
the doctor you see first for most health problems PrimaryCareDoctor
a written order from a primary care doctor for a patient to see a specialist or get certain medical services, often required by HMOs Referral

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

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

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

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

The Healthcare Delivery System Crossword

Type
Crossword
Description

The emphasis of the health care industry is shifting from managing illness to managing health of a community and the environment Population Wellness
What type of care describes a variety of health, personal, and social services provided over a prolonged period Continuing
Type of care that is a service that provides short-term relief or “time off” for people providing home care to people that are ill, disabled, or frail Respite
Health services that are provided in the patients place of residence Home care
Health care services in which patients who are recovering from illness or disability receive rehabilitation and supportive care Restorative
Federally funded national health insurance program for people over 65 years of age in the U.S. Medicare
Facility that offers skilled care from a licensed nursing staff Skilled nursing
Is a caring discipline Nursing
Is a system of family-centered care that allows patients to live with comfort, independence, and dignity while easing the pains of terminal illness Hospice
What health service model shows that population based health care services provide the basis for preventive services Pyramid

Health Insurance Terms Crossword

Type
Crossword
Description

protection in return for periodic premium payments that provides reimbursement of expenses resulting from illness or injury HealthInsurance
the sum of money paid at the time of medical service; it is a form of coinsurance COPAYMENT
An established schedule of fees set for services performed by providers and paid by the patient Feeforservice
A provision of the Insurance Contract that requires the insured to pay a percentage of all eligible medical expenses that result from sickness or injury. Coinsurance
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
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
A request that an insured or the insured’s health care provider makes to the health plan to pay for a health care service provided to the insured. CLAIM
A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. Specialist

Reimbursement Methodologies Crossword

Type
Crossword
Description

Fee schedules are updated by third-party payers. Annually
Performance of Internal - facility based staff (HIM P.) & External - consultants hired for purpose ( corporates that specialize), Scope, Frequency & size of sample depends: size of organ, available resources, number of code profess., history of noncompliance, risk factors, case complexity, results of initial assessments Auditing
Per person premiums, provide all contracted hc services that the covered individuals needs over a specific period of time, calculated on project cost - per patient per month or per member per month Capitation
A Healthcare program for dependent and survivors of permanently and totally disabled veterans CHAMPVA
A medical condition that coexists with the primary cause for hospitalization and affects the patient's treatment and length of stay Comorbidity
A medical condition that arises during an inpatient hospitalization (for example, a postoperative wound infection) Complication
The amount of money that the patient is responsible for before the insurance kicks in is called the Deductible
The computer software program that assigns appropriate MS-DRGS according to information provided for each episode of care is called a Grouper
Which of the following is not a place where PACE services can be provided? Hospice
Which of the following plans reimburses patients up to a specified amount? Indenmity
Title XIX of the Social Security Act Amendment of 1965 is also known as MEDICAID
In this model, healthcare services are contracted with two or more multispecialty group practices instead of just one Network
What data set is used for patient assesments by the home health prospective payment system? OASISC
A payment under the medicare outpatient prospective payment system that includes items such as anesthesia, supplies, certain drugs, and the use of recovers and observation rooms Packaging
Which of the following terms is used for the amount charged for a medical Premium
The MS DRG prospected payment system rate is based on what type of diagnosis? Principal
The type of payment system where the amount of payment is determined before the service is delivered is called Prospective
What is the name of the federally funded program that pays the medical bills of TRICARE
Uses multiple codes that Describe individual components of a procedure rather than an appropriate single code that describes all steps of procedure preformed. Unbundling
Assigning a diagnosis/procedure code specifically for purpose to obtain higher payment Upcoding
Upon which criterion is Medicaid eligibility-based? Income

Health Insurance Crossword

Type
Crossword
Description

A system of health care in which patients agree to visit only certain doctors and hospitals Managed care
The acronym for Health Maintenance Organization. HMO
Also known as a primary care physician. Gate Keeper
What is the amount you pay for health care services before your health insurance begins to pay? Deductible
A sum paid to cover money that has been spent or lost. Reimbursement
A federal law that is sometimes called the "privacy rule". HIPAA
What type of claim form is used by a hospital? UB04
Meaning of PPO. Preferred Provider Organization
Having inadequate insurance coverage. Underinsured
The insured pays a share of payment made against a claim. Coinsurance
A federal system of health insurance for those requiring financial assistance. Medicaid
Federal health insurance program for people 65 years or older. Medicare
Dental benefits Employer Sponsored Coverage
A payment owed by the person insured at the time a covered service is rendered, covering part of the cost of the service. Copayment
Provides health care and financial protection. Universal Health Insurance
M48.1 is an example of what type of code? ICD104
Organization paying for some serious treatments people need. Third Party System
Subscription medical, less restrictive than HMO. PPO
Focus solely on preventative care. Preventative Care
Government pays for all health cost. Single Payer System
Not covered by insurance. Uninsured
Premium cost and medical expenses by health care plan. Cost Sharing

Paycheck Basics Crossword

Type
Crossword
Description

Amount subtracted from gorss pay Deductions
wages going directly to employee's bank account from eemployer's Direct Deposit
Federal Insurance Contribution Act: including social security and medicare FICA
Form used to prove citizenship Form I-9
States the amount of money earned and taxes paid throughout the previous year: wage and tax statement Form W-2
Determines the amount of money withheld for taxes: Employee's Withholding Allowance Certificate Form W-4
Total amount of money earned before payroll withholdings Gross Income
Health program for disabled and elderly Medicare
Amount of check often referred to as the "Take home Pay" Net Income
Length of time for which an employee's wages are calculated Pay Period
Paper Payment for earned wages Paycheck
Document that employee's receive either as a notice of payment and deductions Paycheck stub
Electronic card that carries the earned wages on it Payroll card
Items deducted from gross income Payroll deductions
Provides retirement income for the elderly and pays for disability benefits Social Security
Net income and the amount and employee receives after payroll deductions Take Home Pay
Required charges of citizens by local, state, and federal governments Taxes
Amount required by law for employers to withhold from earned wages to pay taxes Withholding Tax
Accumulated deductions for the year Year to Date