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






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






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






4. 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






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






6. Billing for services not performed






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






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






9. 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






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






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






13. 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






14. 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






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






16. 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






17. Individually identifiable health information






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






19. 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






20. 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






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






22. 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






23. A review of the need for inpatient hospital care - completed before the actual admission






24. 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






25. 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






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






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






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






29. 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.






30. American Medical Association






31. A patient claim is eligible for medicare and medicaid






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






33. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services






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






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






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






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






38. 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.






39. 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






40. 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






41. 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.






42. A rule - condition - or requirement






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






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






45. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.






46. Is a provider who sends the patients for testing or treatment






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






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






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






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