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






2. 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






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






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






5. 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






6. 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






7. 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






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






9. A willful act by an employee of taking possession of an employer's money






10. 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






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






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






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






14. 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






15. 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






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






17. 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.






18. A person who protects the computer and networking systems within the practice and implements protocols such as password assignment - backup procedures - firewalls - virus protection - and contingency planning for emergencies.






19. 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






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






21. 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






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






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






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






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






26. 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






27. 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






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






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






30. 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






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






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






33. 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






34. 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






35. A patient claim is eligible for medicare and medicaid






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






37. 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.






38. 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






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






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






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






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






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






44. 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






45. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.






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






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






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






49. 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.






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