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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 list of the amount to be paid by an insurance company for each procedure service






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






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






4. 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






5. 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)






6. A nonprofit integrated delivery system






7. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible






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






9. A rule - condition - or requirement






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






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






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






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






14. 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






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






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






17. Medical staff member who is legally responsible for the care and treatment given to a patient.






18. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).






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






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






21. 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






22. 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






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






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


25. 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






26. 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






27. 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






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






29. American Medical Association






30. 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






31. Under HIPAA - a document given to the patient at the first visit or at enrollment explaining the individual's rights and the physician's legal duties in regard to protected health information.






32. 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






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






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






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






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






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






38. Health Information Portability and Accountability Act






39. Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained.






40. 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






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






42. 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






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






44. 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






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


46. 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






47. 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






48. 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






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






50. 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.