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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. Also known as out-of-network provider. A healthcare provider who has not contracted with the carrier of a health plan to be a participating provider of healthcare






2. The maximum amount a plan pays for a covered service






3. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc






4. Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained.






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






6. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage






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






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






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






10. 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






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






12. The dates of healthcare services were provided to the beneficiary






13. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.






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






15. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment






16. A review of the need for inpatient hospital care - completed before the actual admission






17. This law mandates reporting - disclosure of grievance and appeals requirements and financial standards for group life and health. Self insured plans are regulated by this law






18. Billing for services not performed






19. 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






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






21. The maximum amount a plan pays for a covered service






22. A document that is not required before physicians use or disclose protected health information for treatment - payment - or routine health care operations of the patient. (For other purposes - see Authorization form)






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






24. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan






25. A list of the amount to be paid by an insurance company for each procedure service






26. Health Information Portability and Accountability Act






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






28. Under HIPAA - regulations related to the security of electronic protected health information that - along with regulations - related to electronic transactions and code sets - privacy - and enforcement - compose the Administrative Simplification prov






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

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30. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment






31. 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






32. 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






33. Approval or consent by a primary physician for patient referral to ancillary services and specialists






34. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered






35. A person - who on behalf of the covered entity - performs or assists in the performance of a function or activity involving the use or disclosure of individually identifieable health information.






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






37. Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained.






38. 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






39. Medical staff member who is legally responsible for the care and treatment given to a patient.






40. Individually identifiable health information






41. A rule - condition - or requirement






42. 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






43. Medical services provided on an outpatient basis






44. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO






45. 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






46. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry






47. Integrating benefits payable under more than one health insurance.






48. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.






49. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO






50. 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