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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. 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






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






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






5. 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






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






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






8. 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






9. 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






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






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






12. 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






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






14. 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






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






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

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






18. A rule - condition - or requirement






19. Billing for services not performed






20. 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






21. 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






22. 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






23. 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






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






25. 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






26. The amount of actual money available to the medical practice






27. Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained.






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






29. A patient claim is eligible for medicare and medicaid






30. 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






31. 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.






32. 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






33. A document that is not required before physicians use or disclose protected health information for treatment - payment - or routine health care operations of the patient. (For other purposes - see Authorization form)






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






35. 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






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






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






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






39. 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






40. 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






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






42. 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.






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






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






45. 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.






46. 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






47. 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






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






49. 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






50. 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