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






2. 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






3. 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






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






5. 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






6. 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






7. Medical services provided on an outpatient basis






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






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






10. 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






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






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






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. 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






15. Billing for services not performed






16. 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






17. 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.






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






19. 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






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






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






22. 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






23. The amount of actual money available to the medical practice






24. 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






25. Individually identifiable health information






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






27. 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






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






29. 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






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






31. Unauthorized release of information






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






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






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






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






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






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






38. 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






39. 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






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






41. A patient claim is eligible for medicare and medicaid






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






43. 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






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






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


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






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






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 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






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