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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 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






2. 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






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






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






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






6. 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






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






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






9. 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






10. 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






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






12. Coverage for the treatment obtained from a non-participating provider. Typically - it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider






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






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






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






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






17. Standards of conduct generally accepted as a moral guide for behavior.






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






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






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






21. A nonprofit integrated delivery system






22. Billing for services not performed






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






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






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






26. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost






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






28. 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






29. 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






30. 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.






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






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






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






34. 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






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






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 patient claim is eligible for medicare and medicaid






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. A privileged communication that may be disclosed only with the patient's permission.






40. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost






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






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






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






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






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






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






48. 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






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






50. 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







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