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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 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






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






3. 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






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






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






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






7. 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






8. 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)






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






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






11. A list of the amount to be paid by an insurance company for each procedure service






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






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






14. 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






15. A rule - condition - or requirement






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. 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






18. 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






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






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

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






22. 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.






23. 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






24. 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






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






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






27. Health Information Portability and Accountability Act






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






29. 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






30. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed






31. 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






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






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

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34. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry






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






36. Individually identifiable health information






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






38. 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






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






40. 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






41. 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






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






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






44. 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






45. Medical services provided on an outpatient basis






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






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






48. 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






49. 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.






50. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis