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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. An insurance plan requirement in which you or your primary care physician need to notify your insurance company in advance about certain medical procedures in order for those procedures to be considered a covered expense






2. 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






3. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee






4. 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






5. Verbal or written agreement that gives approval to some action - situation - or statement.






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






7. Health Information Portability and Accountability Act






8. 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.






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






10. A physician who is part of am managed care plan that provides all primary health care services to members of the plan






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






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






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






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






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






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






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






18. 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






19. A nonprofit integrated delivery system






20. 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






21. 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.






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






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






24. 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






25. 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.






26. 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






27. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee






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






29. 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






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






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






32. 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






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






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






35. 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






36. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members






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






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






39. 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






40. 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






41. Medical services provided on an outpatient basis






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






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






45. 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






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






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






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






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






50. A physician who is part of am managed care plan that provides all primary health care services to members of the plan