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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. 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






2. 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






3. 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






4. 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






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






6. 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.






7. 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.






8. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician






9. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member






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






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






12. 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.






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






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

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15. 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






16. 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.






17. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment






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






19. 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.






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






21. American Medical Association






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. 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






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






25. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member






26. 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






27. 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






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






29. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment






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






31. 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






32. 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






33. A rule - condition - or requirement






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






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






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






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






38. 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






39. 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






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






41. 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






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






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






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

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45. 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






46. 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






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






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






49. 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)






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