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

Insurance Terms Crossword

Type
Crossword
Description

Business person who analyzes the probabilities of risk/risk management. Actuary
Person who sells, services, or negotiates insurance policies either with a company or individually. Agent
Physical injury that can include sickness/disease to a person Bodily Injury
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. Coinsurance
The date when an insurance company issues a policy. Date of Issue
Portion of the insured loss paid by the policyholder Deductible
Amount at which an asset can be bought or sold in a transaction between willing parties. Fair Value
The termination of a policy due to failure to pay the required renewal premium. Lapse
It is a state assistance program, to provide hospital and medical expense insurance to people over 65 years of age. Medicare
Money charged for the insurance coverage reflecting expectation of loss. Premium
Uncertainty including the possibility of loss by an unexpected event for which insurance is used for. Risk
homeowners insurance sold to tenants living in the described property. Tenants
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 Underwriter
Insurance that will cover an employer’s liability for injuries or death to people in their employment Workers' Compensation
The amount that has to be paid by the insured person during a calendar year before the insurer is responsible for more loss costs Deductible

Insurance Review Crossword

Type
Crossword
Description

Provides payments for both liability and property insurance on a vehicle automobile-insurance
Receives money if a person dies beneficiary
Out-of-pocket money paid by policyholder before an insurance company deductible
Money paid for health care health-insurance
Financial product purchased to protect one against the risk of loss insurance
The chance of loss from an event that cannot be entirely controlled risk
Someone who relies on someone else for income dependent
Provides payment payment beneficiaries who were named by the insured person life-insurance
When the act of insuring an event increases the likelihood that the event will happen moral-hazard
A person who owns the insurance policy policyholder
The money paid to an insurance company to purchase policy premium
Cash set aside that can be used to cover the costs of unexpected expenses emergency-savings
A formal request to an insurance company asking for a payment when the policyholder has an accident, illness, or injury claim
Requires the insured individual to pay a fixed percentage of the loss after the deductible has been paid co-insurance
Provides payments to replace earnings during times when workers cannot work due to illness or injury disability-insurance
Employers may offer employees benefits in the form of products of services that add extra value for the employee beyond earned wages employee-benefits
The donation of a product or service in place of cash in-kind-income

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

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

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

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

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

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

Medicare 101 Crossword

Type
Crossword
Description

Groups of drugs that have a different cost for each group. Tier
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. Appeal
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. Assignment
A geographic area where a health insurance plan accepts members if it limits membership based on where people live. Service area
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. Step therapy
A person who has health care insurance through the Medicare or Medicaid programs. Beneficiary
The way that Original Medicare measures your use of hospital and skilled nursing facility (SNF) services. Benefit period
A written order from your primary care doctor for you to see a specialist or get certain medical services. Referral
A request for payment that you submit to Medicare or other health insurance when you get items and services that you think are covered. Claim
An amount you may be required to pay as your share of the cost for services after you pay any deductibles. Coinsurance
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. Penalty
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. Prior authorization
The amount you must pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay. Deductible
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 Exception
A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Formulary
A complaint about the way your Medicare health plan or Medicare drug plan is giving care. Grievance
Health care that you get when you're admitted to a health care facility, like a hospital or skilled nursing facility. Inpatient care
The facilities, providers, and suppliers your health insurer or plan has contracted with to provide health care services. Network

Insurance Key Terms Crossword

Type
Crossword
Description

a situation involving exposure to danger. "flouting the law was too much of a risk" risk
(in business) the forecasting and evaluation of financial risks together with the identification of procedures to avoid or minimize their impact risk management
a practice or arrangement by which a company or government agency provides a guarantee of compensation for specified loss, damage, illness, or death in return for payment of a premium. "many new borrowers take out insurance against unemployment or sickness" insurance
a person or group in whose name an insurance policy is held. policy holder
An insurance premium is the amount of money that an individual or business must pay for an insurance policy. The insurance premium is considered income by the insurance company once it is earned, and also represents a liability in that the insurer must provide coverage for claims being made against the policy. policy premium
a course or principle of action adopted or proposed by a government, party, business, or individual. "the administration's controversial economic policies" policy
the extent to which something is probable; the likelihood of something happening or being the case. "the rain will make the probability of their arrival even greater" probability
state or assert that something is the case, typically without providing evidence or proof. "he claimed that he came from a wealthy, educated family" claim
the extent to which something deals with or applies to something else. "the grammar did not offer total coverage of the language" coverage
able to be deducted, especially from taxable income or tax to be paid. "child-care vouchers will be deductible expenses for employers" deductible
covered by insurance insured
a person or company that underwrites an insurance risk; the party in an insurance contract undertaking to pay compensation. insurer
the state of being responsible for something, especially by law. "the partners accept unlimited liability for any risks they undertake" liability
serious and immediate danger. "his family was in peril" peril
a danger or risk. "the hazards of smoking hazard
DEFINITION of 'Insurance Risk Class' A group of individuals or companies that have similar characteristics which is used to determine the risk associated with underwriting a new policy and the premium that should be charged for coverage. insurable risk
DEFINITION of 'Uninsurable Risk' A hazard or condition that has either a high likelihood of loss, or in which the insurance would be considered against the law. Insurance companies limit their losses by not taking on certain risks that are very likely to soon result in a loss. uninsurable risk