Across
- 4. a person who is financially responsible for the bill from the practice
- 7. amount a beneficiary must pay at the time of the visit
- 8. intentional deceptive act to obtain a benefit
- 9. a organized collection of related data items having a specific structure (where data is stored)
- 10. prior authorization from a payer for services to be provided (also called precertification)
- 13. a federal and state assistance program that pays for healthcare services for people who can not afford them ( always paid last if they have other policies)
- 14. amount the insured must pay for healthcare services before a health plan's payment begins
- 15. disclosure of PHI that is not approved and could pose significant risk to the affected person
- 16. and adult legally responsible for the care and custody of a minor
- 19. failure to perform duties properly according to the state-required standard of care
Down
- 1. standard of conduct based on moral principles
- 2. a fixed prepayment covering provider's services for a plan member, whether they go to the doctor or not, doctor gets paid
- 3. policyholder, guarantor, or subscriber
- 5. this form list the diagnoses, procedures and the charges for a patient's visit
- 6. the first step (of 10) in the medical billing cycle
- 10. person or entity that supplies medical or health services and bills for, or is paid for services
- 11. health plan process of examining claims and determining benefits
- 12. transfer of patient care from one provider to another
- 17. action that misuses money (ex. billing for a service not medically necessary)
- 18. a group of healthcare providers, including physicians and hospitals, who sign a contract with a health plan to provide services to plan members