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






2. Health Information Portability and Accountability Act






3. 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






4. 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






5. 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






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






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






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






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






10. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved






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






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






13. 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






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






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






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






17. 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






18. 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






19. 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






20. 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






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






22. Billing for services not performed






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






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






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






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






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






28. 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






29. 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






30. Billing for services not performed






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






32. The condition of being secluded from the presence or view of others.






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






34. 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






35. 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






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






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






38. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved






39. 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






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






41. American Medical Association






42. 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.






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






44. 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.






45. 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






46. 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






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

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48. 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.






49. 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






50. Unauthorized release of information