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






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






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






4. The Medicare program that pays for a protion of the cost of physicians' services - outpatient hospital services and other related medical and health services for voluntarily insured aged and disabled individuals






5. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment






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






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






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






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






10. The transmission of information between two parties to carry out financial or administrative activities related to health care.






11. 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






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






14. 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






15. A nonprofit integrated delivery system






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






17. 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






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

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19. 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.






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






22. 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.






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






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






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






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






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






28. 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






29. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment






30. 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






31. 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






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






33. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services






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






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






36. Billing for services not performed






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






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






39. 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






40. A rule - condition - or requirement






41. A patient claim is eligible for medicare and medicaid






42. 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.






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






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






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






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






47. 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






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. Unauthorized release of information






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







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