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






2. 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






3. 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






4. 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






5. 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






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






7. 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






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






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






10. 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.






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






12. Approval or consent by a primary physician for patient referral to ancillary services and specialists






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






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






15. 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






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






17. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology






18. A flexible health care plan that allows patients to choose using the panel of providers within the HMO network or to utilize the services of non HMO providers






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






20. American Medical Association






21. 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






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






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






24. 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






25. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost






26. 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






27. 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






28. 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






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






30. 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






31. 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






32. 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






33. Unauthorized release of information






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






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






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






37. Medical services provided on an outpatient basis






38. 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






39. 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






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






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






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






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. 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






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






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






47. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area






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


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






50. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment