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Ch. 17 Insurance and Billing

Teacher: SREvans
Across
A fixed or set amount paid for each healthcare or medical service
Medicare _______ ___ is for prescription drug plan coverage
______ advice is a form that the patient and the practice receive for each encounter that outlines the amount billed by the practice, the amount allowed, the amount of subscriber liability, the amount paid, and notations of any service not covered, including an explanation of why that service is not covered.
______ + Choice Plan is a medicare benefit in which beneficiaries can choose to enroll in one of three major types of plans instead of the original Medicare.
_________ compensation is an insurance that covers employment related accidents or diseases.
This is the abbreviation for resource-based relative value scale
This is the authorization or approval for payment from a third-party payer requested in advance of a specific procedure.
This is a group that takes nonstandard medical billing software formats and translates them into the standard EDI formats
______ rule is a rule that states that the insurance policy of a policyholder whose birthday comes first in the year is the primary payer for all dependents.
_____ procedure is a medical procedure that is not required to sustain life but is requested for payment to the third-party payer by the patient or the physician.
This is the abbreviation for explanation of benefits
Explanation of ______ is document sent by insurance carrier when payment is made describing the terms of the payments.
Medicare _______ ____ provides several plan choices for individuals called Medicare Advantage Plus.
______ schedule is a list of the costs of common services and procedures performed by a physician.
This is a fixed percentage of covered charges paid by the insured person after a deductible has been met.
Medical _____ __ is the hospital benefits, which is billed by hospitals and financed through contributions collected from the Federal Insurance Contributions Act tax on income earned by workers and the self-employed.
Down
This is the abbreviation for explanation of payment
This is a payment structure in which a health maintenance organization prepays an annual set fee per patient to a physician
This is the abbreviation for health maintenance organization
_____ charge is the amount that is the most the payer will pay any provider for each procedure or service.
______ coverage is a term that is used when a patient is covered by Medicare and Medicaid
This is a major type of health plan. It repays policyholders for the costs of healthcare that are due to illness and accidents
_____-party player is a health plan that agrees to carry the risk of paying for patient services.
Medical ______ ___ covers a portion of the allowed charges for a wide range of outpatient procedures and supplies.
_______ provider organization is a managed care plan that establishes a network of providers to perform services for plan members
A fixed dollar amount that must be paid by the insured before additional expenses are covered by an insurer
_________ of benefits is information that explains the medical claim in detail.
This is a national health insurance program for A mericans ages 65 years old or older
The basic annual cost of healthcare insurance
______ maintenance organization is a healthcare organization that provides specific services to individuals and their dependents who are enrolled in the plan.
This is the abbreviation for preferred provider organization