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






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. 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






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






5. 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






6. 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.






7. 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.






8. 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






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. 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






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






12. 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






13. Health Information Portability and Accountability Act






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






15. 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.






16. 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.






17. 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






18. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists






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






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






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






22. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.






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






24. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.






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






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






27. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed






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






29. 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






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






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






32. 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






33. 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






34. A specific period of time in which employees may change insurance plans and medical groups offered by their employer and have the new insurance effective at a later date






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






36. 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.






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 rule - condition - or requirement






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






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






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






42. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed






43. 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






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






45. 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






46. A privileged communication that may be disclosed only with the patient's permission.






47. Unauthorized release of information






48. 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






49. A patient claim is eligible for medicare and medicaid






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