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






2. Unauthorized release of information






3. 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






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






5. A clinic that is owned by the HMO and the physicians are employees of the HMO






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






7. American Medical Association






8. 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






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






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






11. A rule - condition - or requirement






12. 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






13. 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






14. Is a provider who sends the patients for testing or treatment






15. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc






16. 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






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






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






19. 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






20. Approval or consent by a primary physician for patient referral to ancillary services and specialists






21. Billing for services not performed






22. Individually identifiable health information






23. The condition of being secluded from the presence or view of others.






24. 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)






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






26. American Medical Association






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. 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






29. 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






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






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






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






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






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






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






36. 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






37. 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






38. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry






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

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






41. 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






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






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






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






45. 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






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






47. Unauthorized release of information






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






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