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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. 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






2. 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






3. 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






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






5. American Medical Association






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






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






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






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






10. 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






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






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






13. A rule - condition - or requirement






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






15. An organization of provider sites with a contracted relationship that offer services






16. 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






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






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






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






20. 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






21. 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






22. A nonprofit integrated delivery system






23. 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






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






25. 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






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






27. 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.






28. Medical services provided on an outpatient basis






29. 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






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






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






32. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members






33. 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






34. 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.






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






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






38. Billing for services not performed






39. A document signed by the patient that is needed for use and disclosure of protected health information for purposes other than treatment - payment or health care operations






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






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






42. 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)






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






44. 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.






45. 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






46. A nonprofit integrated delivery system






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






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






49. Medical services provided on an outpatient basis






50. 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.







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