Insurance Billing/Terminology Crossword
Type
Crossword
Description

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

PATIENT ACCESS Crossword

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
Fixed sum of money that beneficiary must contribute towards the cost of their healthcare before insurance benefits begin
Official count/list of patient population
Not to be disclosed
Federal health insurance plan primarily for seniors
The administrative branch within the Department of Health and Human Services that is responsible for Medicare and Medicaid Services
ost sharing in which the subscriber is responsible for a specific percentage of the cost of healthcare
Person who is the holder of an insurance policy
Questionnaire to determine primary payor before Medicare
ederal law requiring employers to permit employees to continue their group health insurance coverage after termination
A fixed payment for a covered service
Preferred Provider Organization
oint federal and state program to provide Medical insurance for the poor
Collection and storage on patient demographic, insurance, and clinical data

Basics of Health Insurance Crossword

Basics of Health Insurance Crossword
Type
Crossword
Description

An established schedule of fees set for services performed by providers and paid by the patient
protection in return for periodic premium payments that provides reimbursement of expenses resulting from illness or injury
the sum of money paid at the time of medical service; it is a form of coinsurance
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
Civilian Health and Medical Program of the Veterans Administration known as
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.
A term used in managed care for an approved referral
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.
a letter or statement from Medicare that describes what was paid, denied, or reduced in payment.
Pays expenses involved in the care of the teeth and gums
Protects a person in the event of a certain type of accident, such as an airplane crash
Often includes benefits for medical expenses payable to individuals who are injured in the insured person’s home or during an automobile accident
Covers a continuum of maintenance and health services for chronically ill, disabled, or mentally retarded individuals
Provides payment of a specified amount on the insured’s death
Pays the cost of all or part of the insured person’s hospital room and board and specific hospital services
a review of individual cases by a committee to make sure services are medically necessary and to study how providers use medical care resources
40. An insurance term used when a primary care provider wants to send a patient to a specialist
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
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
a general practice or nonspecialist provider or physician responsible for the care of a patient for some health maintenance organizations

Healthcare Vocabulary Crossword

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
Reffered to as family doctor/PCP this person administers routine and preventive care, and makes referrals for specialty services when needed.
A provider who focuses on one area of medicine. Like a cardiologist or neurologist
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.)
The contracted rate a health insurance company will pay toward a specific medical service.
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).
A pre-determined annual amount patient must pay before insurance begins to cover.
Annual maximum amount patient is required to pay for in-network medical services per his/her insurance plan contract (typically, copay + coins + deductible)
The person who is responsible for payment of the monthly premium, or whose employment is the basis for the coverage.
A person entitled to health insurance benefits under the subscriber’s plan.
Insurance Company
A specific package of benefits negotiated between the company and the employer.
Dates during which the insurance plan is active.
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.
/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.)
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.
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.
The process whereby a physician must obtain insurance approval before a patient receives certain treatment or drugs (study, test, procedure, surgery.)

Insurance Terms Crossword

Insurance Terms  Crossword
Type
Crossword
Description

Business person who analyzes the probabilities of risk/risk management.
Person who sells, services, or negotiates insurance policies either with a company or individually.
Physical injury that can include sickness/disease to a person
A clause in most property insurance policies to encourage policyholders to carry a good amount of insurance. If the insured person doesn’t maintain the amount specified in the clause (usually 80%), the insured person will share a higher proportion of the loss.
The date when an insurance company issues a policy.
Portion of the insured loss paid by the policyholder
Amount at which an asset can be bought or sold in a transaction between willing parties.
The termination of a policy due to failure to pay the required renewal premium.
It is a state assistance program, to provide hospital and medical expense insurance to people over 65 years of age.
Money charged for the insurance coverage reflecting expectation of loss.
Uncertainty including the possibility of loss by an unexpected event for which insurance is used for.
homeowners insurance sold to tenants living in the described property.
The person who identifies and classifies the degree of risk posed by the person trying to be insured. They determine whether or not coverage should be provided and what the rate should be
Insurance that will cover an employer’s liability for injuries or death to people in their employment
The amount that has to be paid by the insured person during a calendar year before the insurer is responsible for more loss costs

Hospital Billing Crossword

Hospital Billing Crossword
Type
Crossword
Description

National Provider Identification
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.
Portion of the bill, as defined by the insurance company which the patient owes.
Advanced Beneficiary Notice
A person or persons whose account that has been sent to a collection agency for further action.
The cost sharing part of the bill that the patients have to pay.
A part of the bill that we must write off because of billing agreements with insurance companies.
A cost sharing part of the bill that is the patient’s responsibility to pay.
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
How much cost sharing that the patient must pay for medical services often before their insurance starts to pay.
A code used for billing that describes the patient’s condition. Also called ICD-10 diagnosis code.
Individual who is responsibility for the bill.
Patient class in which the patient requires a higher degree of nursing and physician care.
A person who is a policyholder of the insurance. Also known as the subscriber, policyholder, cardholder, or beneficiary.
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.
Any service received at a hospital or clinic that is not an inpatient status. Includes Emergence Room, Observation, and ancillary services.
A form used by hospitals to file insurance claims for medical services. Used when billing for hospital technical services.
Part of medicare that helps pay for doctor services, outpatient care, and other medical services not paid for by Medicare Part A.
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.
Claim form used by doctors to file insurance claims for medical services. Used when billing for professional services.
Medicare Secondary Questionnaire
Hospital Billing (abv)
Professional Billing (abv)
After a patient is discharged from, the account status is changes from Open to
Hospital Account
A holding tank for accounts that we have identified has issues or needs follow up performed
Hospital Clinic System used by WVUH

Patient Access Crossword

Patient Access  Crossword
Type
Crossword
Description

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

Health Insurance Crossword Puzzle

Health Insurance Crossword Puzzle
Type
Crossword
Description

What does the acronym PPO stand for?
What is the acronym for Health Maintenance Organization?
There are two types of medical billing: Institutional and _______________________.
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.
What type of claim form is used by hospitals?
Another name for a Health Information Specialist is a _________________________ Specialist.
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.
What is the amount you pay for health care services before your health insurance begins to pay?
A __________ is a fixed amount you pay for a health care service?
A primary care physician is also known as a _______________________.
What is the abbreviation for out-of-network?
What is the abbreviation for in-network?
What type of managed care plan lets you choose between an HMO or a PPO each time you need care?
How many parts does Medicare have?
A 1996 federal law that is sometimes called the "privacy rule", outlining how certain entities can use or disclose personal health information.
The reason for the visit or surgery that defines the disease process or injury.
M48.1 is an example of what type of code?
What does UB stand for in UB-04?
The healthcare system, funded by the U.S. Department of Defense, that active and retired military and their dependents use.
The entity that reimburses the provider for services. Insurance companies, Medicare, Medicaid, and third-party administrators are all payers in the healthcare industry.
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 _______________?

Health Insurance Terms Crossword

Health Insurance Terms Crossword
Type
Crossword
Description

protection in return for periodic premium payments that provides reimbursement of expenses resulting from illness or injury
the sum of money paid at the time of medical service; it is a form of coinsurance
An established schedule of fees set for services performed by providers and paid by the patient
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.
A term used in managed care for an approved referral
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.
An insurance term used when a primary care provider wants to send a patient to a specialist
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
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.
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.

Medical Coding and Billing Crossword

Medical Coding and Billing Crossword
Type
Crossword
Description

health plan
reimburse policyhoders for medical sevices
list of selected drugs and their dosage
amount paid for an insurance policy
document that modifies an insurance contract
review of systoms
amount paid at time of service
amount a person pay, usually annual
free service to other physicians
provider who completes the header of an ABN
provides a higher payment
not coded at highest level
identifies improper codes
a condition that remains after an acute illness
a long duration
severe sysmptoms with a short duration

Medical Billing and Coding Crossword

Medical Billing and Coding Crossword
Type
Crossword
Description

a list of medications that will be covered under the insurance plan
a primary care provider who refers patients to other providers for services he/she cannot perform
a physician who substitutes for the patients regualr physician
the process of establishing the medical need for medical services
person who owns a health insurance policy
10-digit identification number assigned to health care providers by the Center of Medicare and Medcaid Services
gatekeeper provider who refers patients to other providers for services he/she cannot perform
the insurance carrier responsible for paying benefits before any other insurer makes a payment
the insurance policy billed first for any health care service
the insurance carrier billed for costs that were not covered by the primary payer
billing seperately for related procedures that were performed together and by law, must be one charge
a physician to whom the patient is expected to pay charges before submitting the claim to the insurance company, which pays the patient directly
a provider who has a contractual agreement with an insurance plan to render care to eligible beneficiaries and then bill the insurance carrie directly
Federal law passed to create a market for puchase of health care insurance policies and mandates and incentives to decrease the number of uninsured Americans
insurance plan in which a patient may choose an HMO or a non-HMO provider
requirement to obtain prior approval for surgery or procedures from the insurance carrier in order to recieve reimbursement
the amount insurance companies consider to be an appropriate fee for a given service
patients written authorization giving the insurance company the right to pay the physician directly for billed charges
a person who is eligible for coverage by government health policies
used to determin which parent's benefit plan will pay for the medical bills of dependent child when the child is covered by both parent's
procedures to prevent duplication of payment by more than one insurance carrier
family member of a health plan member