Chapter 15 Vocab

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Across
  1. 4. A secure online website that gives contracted providers a single point of access to insurance companies. This allows the provider to determine patient eligibility and deductible status, submit preauthorizations/precertifications, and check the status of claims.
  2. 5. An identifier assigned by the Centers for Medicare and Medicaid Services (CMS) that classifies the healthcare provider by license and medical specialties.
  3. 6. A form completed by the patient that authorizes the medical office to release medical records to the insurance company for health insurance reimbursement.
  4. 7. Nonsurgical procedure that uses an endoscope to view inside the body.
  5. 10. The standard insurance claim form used for all government and most commercial insurance companies.
  6. 12. A process completed before claims submission in which claims are examined for accuracy and completeness.
  7. 13. Software that finds common billing errors before the claim is sent to the insurance company.
  8. 14. A set dollar amount that the patient must pay for each office visit. There can be one copayment amount for a primary care provider, a different copayment amount (usually higher) to see a specialist or be seen in the emergency department.
  9. 15. To settle or determine judicially.
Down
  1. 1. A document sent by the insurance company to the provider and the patient explaining the allowed charge amount, the amount reimbursed for services, and the patient's financial responsibilities.
  2. 2. An organization that accepts the claim data from the provider, reformats the data to meet the specifications outlined by the insurance plan, and submits the claim.
  3. 3. A payment arrangement for healthcare providers. The provider is paid a set amount for each enrolled person assigned to him or her, per period of time, whether or not that person has received services.
  4. 8. The process of determining if a procedure or service is covered by the insurance plan and what the reimbursement is for that procedure or service.
  5. 9. Services or supplies (CPT and HCPCS codes) used to treat the patient's diagnosis (ICD codes) that meet the accepted standard of medical practice.
  6. 11. Meeting the stipulated requirements to participate in the healthcare plan.