Ch 15 & 16

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Across
  1. 2. pay for services with their own funds
  2. 3. represent the services and supplies provided to a patient during his encounter with the facility or provider.
  3. 5. is the verification the patient is currently covered by the plan on the date of service and the services provided are covered by the plan.
  4. 6. is the practice of using multiple codes to bill for the various individual steps in a single procedure rather than using a single code.
  5. 8. when someone intentionally executes or attempts to execute a scheme to obtain money or property of any healthcare benefit program.
  6. 10. maintenance organization, is the entity that combines the provision of healthcare insurance and the delivery of healthcare services.
  7. 11. part B, optional and supplemental portion of Medicare for which beneficiaries pay a monthly premium.
  8. 13. the overutilization or inappropriate utilization of services and misuse or resources.
  9. 14. is the systematic comparison of the products services and outcomes of one organization with those of similar organization’s outcomes.
  10. 16. a function that allows retrospective reconstruction of events including who executed the events why and what changes were made.
  11. 17. the practice of assigning diagnostic or procedural codes that represent higher payments rates than the codes that actually reflect the services provided to the patients.
  12. 18. healthcare insurance contract
Down
  1. 1. the person covered by the policy
  2. 4. is the pre-established percentage of eligible expenses after the deductible is met.
  3. 7. the amount of cost, usually annually, the policyholder must incur before the plan will assume liability for the remaining covered expenses.
  4. 9. is a financial management list that contains information about the organization's charges for healthcare services provides to patients,
  5. 10. maintenance organization, is entity that combines the provision of healthcare insurance and the delivery of healthcare services.
  6. 11. part A, insurance covering inpatient care in hospitals
  7. 12. is a cost=sharing measure in which the policyholder pays a fixed dollar amount per service.
  8. 15. is a specified amount of money paid to a healthcare plan or doctor to cover the cost of healthcare plan member’s services.