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






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






3. 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






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






5. 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






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






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






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






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






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






12. 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






13. 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






14. 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.






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

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16. Programs designed to reduce unnecessary medical services - both inpatient and outpatient






17. 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






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






19. 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






20. 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






21. 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






22. 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.






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






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






25. 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






26. 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






27. Health Information Portability and Accountability Act






28. A nonprofit integrated delivery system






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






30. 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.






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






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






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






35. 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






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






37. 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






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






39. 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






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






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






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






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






44. Unauthorized release of information






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






46. 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






47. An organization of provider sites with a contracted relationship that offer services






48. 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)






49. An organization of provider sites with a contracted relationship that offer services






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