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






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






3. 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






4. 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






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






6. 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






7. 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.






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






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






10. A privileged communication that may be disclosed only with the patient's permission.






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

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12. 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






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






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






15. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment






16. 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






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






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






19. 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






20. Medicare's method of paying acute care hospitals for inpatient care






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






22. 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






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






24. Health Information Portability and Accountability Act






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






28. 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)






29. A complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.






30. 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






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






32. 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.






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






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






35. Medical services provided on an outpatient basis






36. 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






37. 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






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






39. 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






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






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






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






43. Approval or consent by a primary physician for patient referral to ancillary services and specialists






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






45. Medicare's method of paying acute care hospitals for inpatient care






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






47. 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






48. 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






49. 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






50. 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