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






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






3. 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






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






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






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






7. 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)






8. 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






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






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






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






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






13. Any healthcare services - that are determined by the insurance plan to be either; not generally accepted by informed healthcare professionals in the U.S. as efective in treating the condition - illness or diagnosis for which their use is proposed; or






14. A nonprofit integrated delivery system






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






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






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






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






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






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






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






22. 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






23. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology






24. 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






25. Unauthorized release of information






26. 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.






27. 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






28. 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






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






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






31. 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






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






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






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






35. An individual designated ot help the provider remain in compliance by setting policies and procedures in place - and by training and managing the staff regarding HIPAA and patient rights; usually the contact person for questions and complaints.






36. A rule - condition - or requirement






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






38. 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






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






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






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






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






43. 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






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






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






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






47. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment






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






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






50. 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