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

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

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.)

Medicare 101 Crossword

Medicare 101 Crossword
Type
Crossword
Description

Groups of drugs that have a different cost for each group.
the action you can take if you disagree with a coverage or payment decision made by Medicare, your Medicare health plan, or your Medicare Prescription Drug Plan.
An agreement by your doctor, provider, or supplier to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance.
A geographic area where a health insurance plan accepts members if it limits membership based on where people live.
A coverage rule used by some Medicare Prescription Drug Plans that requires you to try one or more similar, lower cost drugs to treat your condition before the plan will cover the prescribed drug.
A person who has health care insurance through the Medicare or Medicaid programs.
The way that Original Medicare measures your use of hospital and skilled nursing facility (SNF) services.
A written order from your primary care doctor for you to see a specialist or get certain medical services.
A request for payment that you submit to Medicare or other health insurance when you get items and services that you think are covered.
An amount you may be required to pay as your share of the cost for services after you pay any deductibles.
An amount added to your monthly premium for Part B or a Medicare drug plan (Part D) if you don't join when you're first eligible. You pay this higher amount as long as you have Medicare. There are some exceptions.
Approval that you must get from a Medicare drug plan before you fill your prescription in order for the prescription to be covered by your plan.
The amount you must pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay.
A type of Medicare prescription drug coverage determination, a drug plan's decision to cover a drug that's not on its drug list or to waive a coverage rule
A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits.
A complaint about the way your Medicare health plan or Medicare drug plan is giving care.
Health care that you get when you're admitted to a health care facility, like a hospital or skilled nursing facility.
The facilities, providers, and suppliers your health insurer or plan has contracted with to provide health care services.

Patient Access Week Crossword

Patient Access Week Crossword
Type
Crossword
Description

Meeting where coworker issues are resolved
Federal law requiring employers to permit employees to continue their group health insurance coverage after termination
Health Insurance _____________and Accountability Act
Cost sharing in which the subscriber is responsible for a specific percentage of the cost of healthcare
(2 words) Tool that utilizes fee schedules, payer contracts, and benefits to calculate a cost estimate
(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
An insurance coverage that doesn't require authorization
Fixed sum of money that the beneficiary must contribute towards the cost of their healthcare before insurance benefits begin
The person who is financially responsible for the account
Questionnaire to determine primary payor before Medicare

Medicare Crossword

Medicare Crossword
Type
Crossword
Description

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

Medicare Terms Crossword

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
this visit is available once every twelve months after the first twelve months of Part B coverage
the percentage you pay for covered services after you have met your deductible
a fixed amount one pays to receive a medical service, usually at the time of service
the amount one pays annually before the plan begins to pay. This does not apply to services that require a copay
is long lasting, used for a medical reason, and typically used in an individual's home
ESRD
the plan contract that gives detailed information about the plan, including: what is and is not covered, what an individual pays, etc.
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.
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.
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.
a status for individuals starting when one is formally admitted to a hospital with a doctor’s order
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
in a PPO, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network
the periodic payment to Medicare, an insurance company, or a health care plan for health or prescription drug coverage
services to prevent illness or detect illness at an early stage
the doctor you see first for most health problems
a written order from a primary care doctor for a patient to see a specialist or get certain medical services, often required by HMOs

Health Insurance Crossword

Health Insurance Crossword
Type
Crossword
Description

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

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 Care Systems Crossword

Health Care Systems  Crossword
Type
Crossword
Description

What type of public health care agency is operated by the government?
The U.S. of health and human services is the official agency at what level?
Health activities that take place at the international level go through what organization?
Health care that provides a diverse range of medical services is called?
What is a one day surgical care center?
These provide follow up care to patients after hospitalization
A hospital that is dependent on gifts & donations as a source of revenue
The philosophy of this is to maintain comfort as death approaches
Places for people who are not candidates residing in a nursing home
Home with services that emphasizes privacy and choice
The monthly fee that a person must pay for health care insurance coverage
What takes place after an acute illness or injury?
Care that can be initiated at any stage of illness whether terminal or not
What is the need to hold costs within fixed limits?
Meets the health care needs of our veterans
What program is for adults ages 65 and older?
What program provides medical assistance for low income families?
Independent nonprofit organization that serves as an advisor to improve the nations health

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