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






2. A physician - the majority of whose practice is devoted to internal medicine - family/general practice and pediatrics. An ob/gyn sometimes is considerd a primary care physician depending on coverage






3. 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






4. Health Information Portability and Accountability Act






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






6. 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.






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






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

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






11. American Medical Association






12. A provider of medical or health services and any other person or organization who furnishes bills or is paid for health care in the normal course of business.






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






14. 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






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






16. 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






17. 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






18. A rule - condition - or requirement






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






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






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






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






23. 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






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






25. 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)






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






27. 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






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






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






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. 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.






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 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






34. 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






35. 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






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






37. 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






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






39. 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.






40. 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






41. 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






42. 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






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






44. 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






45. The Medicare program that pays for a protion of the cost of physicians' services - outpatient hospital services and other related medical and health services for voluntarily insured aged and disabled individuals






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






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






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






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






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