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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. Integrating benefits payable under more than one health insurance.






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






3. Medical services provided on an outpatient basis






4. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).






5. 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






6. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).






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






8. 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






9. 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)






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






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






12. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost






13. 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






14. 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






15. 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






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






17. A provider of medical or health services and any other person or organization who furnishes bills or is paid for health care in the normal course of business.






18. 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






19. 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






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






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






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






23. 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.






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






25. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology






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






27. 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






28. Customs - rules of conduct - courtesy - and manners of the medical profession






29. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost






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






31. 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






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






33. Medical services provided on an outpatient basis






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

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35. A flexible health care plan that allows patients to choose using the panel of providers within the HMO network or to utilize the services of non HMO providers






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






37. 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.






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






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






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






41. 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






42. 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.






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






44. Individually identifiable health information






45. Health Information Portability and Accountability Act






46. 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






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






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






49. American Medical Association






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







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