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Medical Coding And Billing Clinical Vocab

Instructions:
  • Answer 50 questions in 15 minutes.
  • If you are not ready to take this test, you can study here.
  • Match each statement with the correct term.
  • Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.
1. Customs - rules of conduct - courtesy - and manners of the medical profession






2. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment






3. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area






4. A provision that apples when a person is covered under more than one group medical program






5. A clinic that is owned by the HMO and the physicians are employees of the HMO






6. An entity that transmits health information in electronic form in connection with a transaction covered by HIPAA. The covered entity may be a helath care coverage carrier such as Blue Cross - a health care clearinghouse through which claims are submi






7. Standards of conduct generally accepted as a moral guide for behavior.






8. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage






9. An organization of provider sites with a contracted relationship that offer services






10. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.






11. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee






12. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner






13. A structure for classifying outpatient services and procedures for purpose of payment






14. A patient claim is eligible for medicare and medicaid






15. The period of time that payment for Medicare inpatient hospital benefits are available






16. An authorization directing the insurer to make payment directly to a provider of benefits - such as a physician or dentist - rather than to the insured






17. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment






18. Someone who is eligible for or receiving benefits under an insurance policy or plan






19. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member






20. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible






21. Medicare's method of paying acute care hospitals for inpatient care






22. An insurance policy - plan - or program thay pays second on a claim for medical care. For children covered under two insurance plans - primary coverage will be determined by the Subscriber (mom and dad) whose month of birth is closest to the beginnin






23. The transmission of information between two parties to carry out financial or administrative activities related to health care.






24. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved






25. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner






26. A willful act by an employee of taking possession of an employer's money






27. Under HIPAA - a document given to the patient at the first visit or at enrollment explaining the individual's rights and the physician's legal duties in regard to protected health information.






28. The amount of actual money available to the medical practice






29. A form signed by the patient showing insurance plans assigned and their billing priority. This form allows the hospital to bill insurance on the patient's behalf and receive payment directly from the payor






30. A form signed by the patient showing insurance plans assigned and their billing priority. This form allows the hospital to bill insurance on the patient's behalf and receive payment directly from the payor






31. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment






32. A physician - the majority of whose practice is devoted to internal medicine - family/general practice and pediatrics. An ob/gyn sometimes is considerd a primary care physician depending on coverage






33. A person who protects the computer and networking systems within the practice and implements protocols such as password assignment - backup procedures - firewalls - virus protection - and contingency planning for emergencies.






34. ABN billing rules permit physicians and other Part B care providers to bill beneficiaries directly when Medicare will not cover services for lack of medical necessity






35. Medical services provided on an outpatient basis






36. A portion of the covered expenses that an insured individual must pay before inusrance coverage with co-insurance goes into effect. Deductibles are usually based on a calander year






37. A practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated






38. A monthly fee paid by the insured for specific medical insurance coverage






39. Is the provider who renders a service to a patient






40. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated






41. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.


42. Coverage for the treatment obtained from a non-participating provider. Typically - it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider






43. Is a provider who sends the patients for testing or treatment






44. Any healthcare services - that are determined by the insurance plan to be either; not generally accepted by informed healthcare professionals in the U.S. as efective in treating the condition - illness or diagnosis for which their use is proposed; or






45. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis






46. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group






47. The most money you can expect to pay for covered expenses. Once the max out-of-pocket has been met - the health plan will pay 100% of certain covered expenses






48. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee






49. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.






50. A group of primary care physicians who have joined together to share the risk of providing care to their patients who are covered by a given health plan