Medical Billing Terminology

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Across
  1. 4. Refers to a category of CPT codes used by healthcare providers to bill for the time and cognitive effort spent assessing a patient’s health and managing their care.
  2. 5. This is a detailed document that lists all the products or services provided to a customer or patients, along with their individual costs, taxes, and any other applicable charges.
  3. 9. Insurance coverage to cover the cost of medical care necessary as a result of illness or injury.
  4. 11. This is the document the insurance must send to the patient and to the provider after they processed the claim
  5. 15. This is a defined amount of time after the premium is due in which a policyholder can make a premium payment without coverage lapsing.
  6. 17. This is a group of Physicians and a business entity organized and owned by a network of independent physician practices to reduce overhead or pursue business ventures.
  7. 18. This is a healthcare professional responsible for translating medical diagnoses
  8. 20. This is a medical record in digital format of a patients hospital or provider treatment
  9. 22. This is an electronic version of an insurance EOB that provides details of insurance claim payments.
  10. 23. When patients pay directly without insurance involvement
Down
  1. 1. If you have insurance coverage through an employer, your insurance card will likely have this number. This numbers help insurance companies identify the benefits included in your employer’s plan and process claims effectively.
  2. 2. This is the savings account from the employer that can be use in paying charges and can rolled-over from year to another year.
  3. 3. Typically a physician, hospital, nursing facility, or laboratory that provides medical care services.
  4. 6. This is a detailed receipt that breaks down every cost. They're useful for tax deductions and filling out expense reports.
  5. 7. Additional code to modified the diagnosis of the patients. E.g, Assigns CPT 66984-50 to indicate the surgery was performed on both eyes
  6. 8. It is a claim submitted for the same service, same date of service, and same patient, often resulting in denial.
  7. 10. An insurance plan in which a provider signs a contract to participate in. The provider agrees to accept a discounted rate for procedures.
  8. 12. This is a unique 10 digit identification number required by HIPAA and assigned through the National Plan and Provider Enumeration System (NPPES)
  9. 13. A type of savings account that lets you set aside money on a pre-tax basis to pay for qualified medical expenses.
  10. 14. Medical service or procedure that is performed on for treatment of an illness or injury that is not considered investigational, cosmetic, or experimental
  11. 16. Claim information is sent electronically from the billing software to the clearinghouse or directly to the insurance carrier.
  12. 19. This code stands for Diagnosis it refers to the standardized language and codes used to describe a patient’s medical condition
  13. 21. It refers to the highest amount a patient will pay in a year for covered healthcare services under their insurance plan.