Billing and claims

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Across
  1. 3. ICD codes are alphanumeric designations given to every diagnosis, description of symptoms and causes of death attributed to humans. Remember: Diagnosis
  2. 4. The most a client must pay for covered services in a plan year. After they spend this amount on deductibles, copayments, and coinsurance for in-network care and services, the health plan pays 100% of the costs of covered benefits
  3. 7. A tax-advantaged account to pay for certain out-of-pocket healthcare costs. Funds do not typically roll over from year to year. “Use it or lose it”
  4. 10. A tax-advantaged account created for individuals who are covered under high deductible plans to cover out-of-pocket healthcare costs. Funds roll over from year to year.
  5. 14. The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible
  6. 15. A health reimbursement arrangement is an employer-funded plan that reimburses employees for qualified medical expenses and, in some cases, insurance premiums.
Down
  1. 1. A statement from your health insurance plan describing what costs it will cover for medical care or products you’ve received. The EOB is generated when your provider submits a claim for the services you received
  2. 2. The amount that an insurance company will pay for a given service code according to the contract. This applies to providers that are in-network with a specific payer.
  3. 5. The timeframe within which a claim must be submitted to a payer. Different payers will have different time frames
  4. 6. A fixed amount ($20, for example) you pay for a covered health care service, even after you've paid your deductible.
  5. 8. The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself.
  6. 9. Third party companies that serve as the middlemen for insurance payors and providers. They check for errors and make claims compatible with payor software. Change Healthcare is our clearinghouse!
  7. 11. A way to figure out who pays first when two or more health insurance plans are responsible for paying the same medical claim.The client is responsible to know what insurance is primary and for updating their COB before claims are submitted.
  8. 12. Also known as service codes, CPT codes are a universal system that identifies medical procedures. Each procedure is given its own unique five digit code that identifies to health insurance companies what type of care was provided! Remember: Time and Type
  9. 13. The electronic transaction that provides claim payment information. These files are used by practices, facilities, and billing companies to auto-post claim payments into their systems