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






2. 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






3. 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






4. 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






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






6. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.






7. 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






8. Billing for services not performed






9. 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






10. 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.






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






12. American Medical Association






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






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






15. 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






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






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






18. Under HIPAA - a document given to the patient at the first visit or at enrollment explaining the individual's rights and the physician's legal duties in regard to protected health information.






19. 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






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






21. A patient claim is eligible for medicare and medicaid






22. Also known as out-of-network provider. A healthcare provider who has not contracted with the carrier of a health plan to be a participating provider of healthcare






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






24. 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






25. A rule - condition - or requirement






26. 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.






27. 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






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






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






30. 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






31. Unauthorized release of information






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






33. 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






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






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






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






37. 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






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






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






40. 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






41. 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






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






43. Health Information Portability and Accountability Act






44. Health Information Portability and Accountability Act






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






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






47. 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






48. 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.






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






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