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






2. 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






3. American Medical Association






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






5. 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.






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






7. 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






8. 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






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






10. 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






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






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






13. Medical services provided on an outpatient basis






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






15. Unauthorized release of information






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






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






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






19. Individually identifiable health information






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






21. 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






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






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






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






25. 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






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






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






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






29. A monthly fee paid by the insured for specific medical insurance coverage






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






31. Billing for services not performed






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






33. 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






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






35. ABN billing rules permit physicians and other Part B care providers to bill beneficiaries directly when Medicare will not cover services for lack of medical necessity






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






37. 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






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






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






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






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






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






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






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






45. 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






46. 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






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






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






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






50. 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.







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