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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 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






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






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






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






5. A nonprofit integrated delivery system






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






7. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.






8. 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






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






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






11. Billing for services not performed






12. A rule - condition - or requirement






13. Health Information Portability and Accountability Act






14. 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






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






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






17. Billing for services not performed






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






19. 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






20. 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






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






22. 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






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






24. 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.






25. 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






26. Unauthorized release of information






27. 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






28. Individually identifiable health information






29. A patient claim is eligible for medicare and medicaid






30. 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






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






32. 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






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






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






35. 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.






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






37. 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.






38. 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






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






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






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

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42. 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






43. 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






44. 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.






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






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






47. 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






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






49. 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






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