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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. 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






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






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






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






5. 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






6. 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)






7. 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






8. 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






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






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. Health Information Portability and Accountability Act






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






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






14. Under HIPAA - regulations related to the security of electronic protected health information that - along with regulations - related to electronic transactions and code sets - privacy - and enforcement - compose the Administrative Simplification prov






15. 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






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






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






18. 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






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






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






22. 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






23. 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






24. A rule - condition - or requirement






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






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






28. 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






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






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






31. A patient claim is eligible for medicare and medicaid






32. Health Information Portability and Accountability Act






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






34. American Medical Association






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






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






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






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






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






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






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






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






43. Unauthorized release of information






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






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






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






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






48. A patient claim is eligible for medicare and medicaid






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






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