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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 nonprofit integrated delivery system






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






3. 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






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






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






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






7. 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






8. 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






9. 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






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






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






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






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






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






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






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






17. A rule - condition - or requirement






18. 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






19. 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






20. 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






21. 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






22. 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






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






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






25. A patient claim is eligible for medicare and medicaid






26. Medical staff member who is legally responsible for the care and treatment given to a patient.






27. 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






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






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






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






31. 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






32. 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






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






34. 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






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

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






37. 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






38. Health Information Portability and Accountability Act






39. 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.






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






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






42. 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






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






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






45. 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






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






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






48. 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.






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






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







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