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






2. 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






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






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






5. American Medical Association






6. A health insurance enrollee chooses to see an out of network provider without authorization






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






8. 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






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






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






11. 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






12. 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






13. Unauthorized release of information






14. An individual designated ot help the provider remain in compliance by setting policies and procedures in place - and by training and managing the staff regarding HIPAA and patient rights; usually the contact person for questions and complaints.






15. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.






16. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services






17. 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






18. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.






19. An individual designated ot help the provider remain in compliance by setting policies and procedures in place - and by training and managing the staff regarding HIPAA and patient rights; usually the contact person for questions and complaints.






20. A provider who has contracted with the health plan to deliver medical services to covered persons. This includes hospitals - pharmacies or a physician who has contractually accepted the terms and conditions as set forth by the health plan






21. Health Information Portability and Accountability Act






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






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






24. 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






25. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.






26. American Medical Association






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






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






29. What the insurance company will consider paying for as defined in the contract.






30. Usually described as a comprehensive inpatient program for those who have experienced a serious illness - injury or disease but who do not require intensive hospital services. This includes infusion therapy - respiratory care - cardiac services - wou






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






32. A document signed by the patient that is needed for use and disclosure of protected health information for purposes other than treatment - payment or health care operations






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






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






35. A managed care system that allows the patient to only select from a defined panel of providers - who are reimbursed on a modified fee-for-service method






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






37. The condition of being secluded from the presence or view of others.






38. 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






39. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician






40. A provider who has contracted with the health plan to deliver medical services to covered persons. This includes hospitals - pharmacies or a physician who has contractually accepted the terms and conditions as set forth by the health plan






41. 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






42. A rule - condition - or requirement






43. An intentional misrepresentation of the facts to deceive or mislead another.






44. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.






45. A document signed by the patient that is needed for use and disclosure of protected health information for purposes other than treatment - payment or health care operations






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






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






48. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.






49. A complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.






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