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






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






3. 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






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






5. A nonprofit integrated delivery system






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






7. A rule - condition - or requirement






8. 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






9. 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.






10. 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.






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






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






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






14. 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






15. 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






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






17. A patient claim is eligible for medicare and medicaid






18. 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






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






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






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






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






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






24. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.






25. 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






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






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






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






29. Medical staff member who is legally responsible for the care and treatment given to a patient.






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






31. 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






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






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






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






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






36. 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






37. 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






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






39. 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






40. 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.






41. 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






42. 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






43. 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






44. 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






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






46. A patient claim is eligible for medicare and medicaid






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






48. 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






49. 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






50. 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