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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 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






2. 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






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. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment






5. 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






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






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






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






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






10. 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.






11. A patient claim is eligible for medicare and medicaid






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






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






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






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






16. A rule - condition - or requirement






17. A rule - condition - or requirement






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






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






20. 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






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. The maximum amount a plan pays for a covered service






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






24. A nonprofit integrated delivery system






25. 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






26. 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






27. 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






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






29. 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






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






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






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 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






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






35. 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






36. 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






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






38. 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






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






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






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






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






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






44. 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






45. Medical services provided on an outpatient basis






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






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






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






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






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