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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. 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.






2. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage






3. 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






4. Medical services provided on an outpatient basis






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






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






7. Unauthorized release of information






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






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






10. Health Information Portability and Accountability Act






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






12. 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






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






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






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






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






17. 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






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






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






20. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage






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






22. A patient claim is eligible for medicare and medicaid






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






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






25. 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






26. A nonprofit integrated delivery system






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






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






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






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






31. 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






32. 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






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






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






35. A complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.






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






37. 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






38. 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






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






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






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






42. Unauthorized release of information






43. 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






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






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






46. The period of time that payment for Medicare inpatient hospital benefits are available






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






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






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






50. 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







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