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






2. Billing for services not performed






3. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee






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






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






6. 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






7. 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.






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






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






10. 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.






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






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

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






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






15. 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






16. 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






17. 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






18. 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






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






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






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






22. 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






23. A patient claim is eligible for medicare and medicaid






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






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






27. 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)






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






29. Health Information Portability and Accountability Act






30. 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






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






32. 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






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. 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






35. 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






36. 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






37. A person who protects the computer and networking systems within the practice and implements protocols such as password assignment - backup procedures - firewalls - virus protection - and contingency planning for emergencies.






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






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






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






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






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






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






44. 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.






45. A managed care system that allows the patient to only select from a defined panel of providers - who are reimbursed on a modified fee-for-service method






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






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






48. 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






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






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