Across
- 5. A service or supply specified in a contract, for which benefits will be provided pursuant to terms of the contract
- 6. Benefits accessible to an insured patient to utilize but who are not contracted with the insurance plan.
- 7. Formerly known as Health Care Financing Administration
- 10. A restriction placed on coverage by private health plans and Medicare private drug plans.
- 11. An universal number assigned to a provider that identifies them as the provider of service to the patient.
- 14. An account available to employees where they have made monetary contributions, usually through payroll deduction, to help offset future healthcare costs.
- 15. Date of service is provided
- 19. Health insurance that covers health care after the primary insurance has been made on a claim for medical or hospital care.
- 20. A patient with no insurance coverage and is responsible for all health care expenses.
- 22. A group of health care providers who give coordinated care and chronic disease management, and thereby improve the quality of care patients get.
- 26. Any arrangement for health care in which an organization acts as an intermediary between the person seeking care and the medical care provider
- 27. Amount of money that is required to be paid by the insured under the insurance contract before any payment is made by the insurer.
- 28. Descriptive list of terms and numeric codes used for reporting diagnostic and therapeutic procedures and other medical services performed by dietitians and other healthcare providers
- 30. A type of health care plan used by companies. The company contracts with a third party administrator or self-administers the health care plan.
- 32. Offered by a private company that contracts with Medicare to provide the person with all Part A and Part B benefits.
- 34. The amount of money charged by the health care provider or supplier for a certain medical service or supply.
- 35. Maximum fee that a third party will use to reimburse a provider for a given service.
- 36. The responsible physician to oversee all aspects of care for a patient.
- 38. A form or document sent by Medicare to explain healthcare services that was paid by your Medicare benefit.
- 39. A method of payment for health services and procedures in which a healthcare provider is paid for each service.
- 41. Provides consumers with greater access to health care insurance, protects the privacy of health care data, and promotes more standardization and efficiency in the healthcare industry.
- 43. Insurance provided through either a for-profit or not-for-profit company rather than by the federal or state government.
- 45. Known as a Federal Tax Identification Number
- 47. A doctor, hospital, health care professional or health care facility.
Down
- 1. A provider who has entered into a contractual agreement with a third party payer for the provision of services to members on an agreed-upon basis, has satisfied credentialing criteria, and has been accepted as such by the third party payer.
- 2. Any information that may be used to identify a patient, including but not limited to name, date of birth, address, phone number, or account number.
- 3. A type of managed care plan that generally covers only the care from providers in this network.
- 4. A professional provider who has not signed a participating provider agreement with a third party payer and is considered out-of-network.
- 8. Covers most medically necessary doctors' services, preventive care, durable medical equipment, hospital outpatient services, laboratory tests, x-rays, mental health care, and some home health and ambulance services
- 9. An optional benefit for prescription drugs available to all people with Medicare for additional charge.
- 12. A revised classification system by the WHO used to report morbidity and mortality information.
- 13. A set amount determined by the third party payer that the insured pays to a provider for the treatment or service.
- 16. A Medicare-approved facility that provides short-term post-hospital extended care services, at a lower level of care than provided in a hospital.
- 17. A model of care provided by physician practices that seeks to strengthen the physician-patient relationship by replacing episodic care based on illnesses an patient complaints with coordinated care and a long-term healing relationship.
- 18. Covers most medically necessary hospital, skilled nursing facility, home health, and hospice care.
- 21. The largest source of funding for medical and health-related services for people with limited income in the US
- 23. Described as the "middle ground" between fee for service reimbursement and capitation.
- 24. Provides health coverage to families with incomes too high to qualify for Medicaid, but can't afford private coverage.
- 25. A program intended to increase primary care services for Medicaid and Medicare patients in rural communities.
- 29. A term used to refer to any company that acts as the payer under coverage provided by a health care plan.
- 31. A statement issued to the insured and the healthcare provider by an insurer to explain the services provided, amounts billed, and payments made by a health plan.
- 33. The federal health insurance program for people 65 years of age or older, certain younger people with disabilities, and people with ESRD.
- 37. A set payment of reimbursement developed by a third party payer to be paid for specific healthcare services and procedures based on CPT/HCPCS codes.
- 40. Can also be referred to as a participating provider.
- 42. Patient classification system used by hospitals to bill and be paid by third party payers.
- 44. Contains vital information about the professional providing the health care service-name, address, registration and licensing/certification. Also contains codes and charges for the service.
- 46. Insured receive full coverage at minimal cost when they use in-network providers in their health care plan, but can opt to receive services from out-of-network providers at a higher cost.