Reimbursement Fundamentals

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Across
  1. 2. the amount paid to the providers office for medical services
  2. 3. managed care organizations
  3. 5. Medicare that covers at 100%
  4. 7. an insurance example of private commercial
  5. 9. the fixed amount that an insured must pay before their insurance will pay
  6. 11. a fixed dollar amount that an insured must pay for medical services
  7. 14. Alternate site of Care
  8. 18. Medicare plan that replaces traditional Medicare
  9. 19. federally or state funded type of insurance
  10. 20. federally and state funded insurance for low income families
  11. 22. also known as MD Purchase
  12. 25. preferred provider organization
  13. 26. Assignment of Benefits
  14. 28. also known as Medicare Replacement Plans
  15. 29. insurance plan for military personal and their families
  16. 30. track payer's reimbursement structure trends and requirements
  17. 32. self administered syringe
  18. 34. Administered, patient administered injections performed at home such as AI and PFS
  19. 35. self administered injection
  20. 36. the amount of money that is paid to healthcare provider from the payer
  21. 37. Injection administered by the healthcare provider such as vial
  22. 39. communicating with payer to determine benefits and coverage
  23. 40. services covered under the plan
Down
  1. 1. site of care were physician can administer the injection
  2. 4. insurance plan for retired veterans
  3. 6. federally funded insurance for disabled or 65 and over or ESRD
  4. 8. out patient facility were physician can administer the injection
  5. 10. when a patient is covered under more than one plan
  6. 12. plan that has open network of providers
  7. 13. the max amount an insured will pay for medical services for the year
  8. 15. a percentage of medical expenses that an insured must pay
  9. 16. B, Medicare that requires yearly deductible and 20% coinsurance
  10. 17. point of service
  11. 21. commercial type of insurance
  12. 23. Pharmacy Benefit Manager
  13. 24. specific codes that are needed to be billed
  14. 27. process of researching and identifying coverage for medication
  15. 31. identifying patient's benefits to ensure eligibility and access options
  16. 33. exclusive provider organization
  17. 38. health maintenance organization