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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 monthly fee paid by the insured for specific medical insurance coverage






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






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






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






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






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






7. 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






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






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






10. 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






11. 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






12. 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






13. 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






14. American Medical Association






15. 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.






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






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






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






19. Health Information Portability and Accountability Act






20. 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






21. 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






22. 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






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






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






25. 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






26. 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






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






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






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






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






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






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






33. Customs - rules of conduct - courtesy - and manners of the medical profession






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






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






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






37. 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.






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






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






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






41. A patient claim is eligible for medicare and medicaid






42. 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






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






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






45. 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.






46. 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






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






49. 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






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







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