Across
- 2. Healthcare providers, often physicians, who serve as the patient’s first contact when entering the healthcare system; also known as a “gatekeeper”.
- 4. Approval from an insurance company prior to receiving certain healthcare services, for the purposes of determining medical necessity and cost effectiveness.
- 11. Healthcare providers, often physicians, who serve as the patient’s first contract when entering the healthcare system; also known as primary care providers
- 12. An agreed-upon amount paid to an insurance company for the benefit of having the company pay for specified amounts of future healthcare costs.
- 15. A classification system of patients based on their diagnoses to predetermine Medicare payments
- 16. The set amount that the patient pays when medical services are received
- 18. Amount due from a customer for services
- 19. Amount of money remaining after all costs of operating a business have been paid.
- 22. Federally funded but state-administered insurance plan for individuals who qualify due to low income.
Down
- 1. Method of payment in which the patient pays the healthcare provider an amount from an established schedule of fees.
- 3. The largest integrated healthcare system in the U.S. serving nine million veterans in 1,250 healthcare facilities, including 172 medical centers and 1,069 outpatient sites.
- 5. A cost-sharing provision in a health insurance contract that stipulates that the insured person is to assume a percentage of the costs of covered services
- 6. The money that must be spent in the process of doing business
- 7. Health plan in which providers contract on a fee-for-service basis with employers, insurance plans, or other third-party administrators.
- 8. Paid back or paid for
- 9. Provides insured healthcare limited to care from providers who work for or contract with the HMO. These providers have agreed to charge less for their services while meeting quality standards. Patients who enroll in these programs must use in-network providers except in emergencies.
- 10. An amount required to be paid under a health insurance contract by the insured before benefits become payable.
- 13. Amount negotiated between insurance companies and healthcare groups for the cost of services; depending on the plan, the patient either pays the difference in actual cost of service or the healthcare group accepts the negotiated amount as payment in full.
- 14. Amount owed to another business for services, supplies, or equipment
- 17. An HMO and PPO hybrid in which members can see an in-network provider for a reduced rate or out-of-network provider for a higher rate.
- 20. Promotion of cost-effective healthcare through the management and control of its delivery.
- 21. A federally funded insurance program that is part of the Social Security Administration and provides health insurance for people aged 65 and older and others, such as the severely disabled, who qualify for social security.