Ch 15 & 16 Crossword Puzzle

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