MOP 110 MEDICAL INSURANCE PRINCIPLES

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Across
  1. 3. Master Document that contains a computer generated list of procedures, services, and supplies with charges for each.
  2. 6. Form A financial form record that documents treated diagnoses and services.
  3. 8. Intentional deception or misrepresentation that could result in an unauthorized payment.
  4. 9. Documented as a letter, signed by the by the provider, explaining why a claim should be reconsidered for payment.
  5. 10. Assignment Provider accepts as payment in full whatever is paid on the claim by the payer (except for any copayment and/or coinsurance amounts).
  6. 11. The person eligible to receive health care benefits.
  7. 12. Judicial dispute resolution process in which a appeals board makes a final determination.
  8. 14. Primary care provider for essential healthcare services at the lowest possible cost, avoiding nonessential care, and referring patient’s specialist
Down
  1. 1. Actions inconsistent with accepted, sound medical, business, or fiscal practices.
  2. 2. Person responsibility responsible for paying health care fees.
  3. 4. Submitting multiple CPT codes when one code should be submitted.
  4. 5. Restricted patient information access to those with proper authorization of patient information.
  5. 7. Report Must accompany a claim when an unlisted procedure or service code is reported to describe the nature, extent, and need for the procedure or service.
  6. 13. Assignment of an ICD-10-CM diagnosis code that does not match patient record documentation for the purpose of illegally increasing reimbursement.