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






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






4. 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






5. 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)






6. 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






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






8. 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






9. A nonprofit integrated delivery system






10. 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






11. 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






12. 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






13. 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






14. 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






15. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.






16. Individually identifiable health information






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

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






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






20. 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






21. 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






22. 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






23. 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.






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






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






26. 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.






27. 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






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






29. A structure for classifying outpatient services and procedures for purpose of payment






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






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






32. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage






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






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






35. A patient claim is eligible for medicare and medicaid






36. 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






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






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






39. An authorization directing the insurer to make payment directly to a provider of benefits - such as a physician or dentist - rather than to the insured






40. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan






41. 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






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






43. 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.






44. 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






45. 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






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






47. Billing for services not performed






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






49. 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






50. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee