Insurance and Billing Terms Crossword

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Across
  1. 5. The amount an insurance company agrees to pay a provider for a specific service. This amount differs from the session charge and can vary based on whether you are in-network or out-of-network with that particular insurance.
  2. 7. A two-digit or alphanumeric code added to a CPT code to provide extra information about the service, required by some insurances for teleheath services, services performed under supervision, etc.
  3. 8. Number Issued by the IRS for businesses and used in place of SSN for tax reporting and payroll. This unique 9 digit number is linked directly to you business and NPI2.
  4. 10. When an insurance claim is processed and reviewed, but the insurer decides not to pay, either partially or entirely, often due to coverage limitations, medical necessity, policy exclusions, or due to missing modifiers.
  5. 12. State Medicaid identifier (term often used in Oregon and some other states) needed if you plan to bill Medicaid.
  6. 13. Code, A five-digit code used to describe services provided by healthcare professionals. It informs insurers about the service performed, enabling them to determine how to reimburse.
  7. 15. The process of establishing agreements with insurers regarding covered services, reimbursement rates, and billing rules. After contracting is completed, the provider is considered “in-network” with that insurance.
  8. 16. Document from insurer explaining how a claim was processed, what was paid, denied, or adjusted, and why.
  9. 17. The amount a client must pay before insurance begins to cover services.
Down
  1. 1. A detailed itemized list of services provided to the patient, generated from the EHR. Superbills include CPT/HCPCS codes, ICD codes, and fees and can be used by patients to submit for reimbursement or by billing staff to create insurance claims.
  2. 2. Fixed amount the client pays per session.
  3. 3. Percentage of cost the client pays after the deductible is reached.
  4. 4. Medicare-issued identifier number that identifies you as a Medicare-enrolled provider.
  5. 6. Similar to a scrub error, this occurs when the EHR submits the claim to insurance, but the insurance rejects the claim and refuses to process it. These errors typically involve missing or incorrect codes, patient information, or insurance details, preventing the claim from being processed by insurance.
  6. 9. The process of an insurance company verifying a provider’s qualifications, licensure, education, and experience.
  7. 11. Electronic Funds Transfer, The electronic movement of money from payer to provider (or between bank accounts) instead of paper checks. In healthcare, used to deposit insurance payments directly into provider accounts.
  8. 14. Maximum, The most a client pays in a year; after that, insurance covers 100%.