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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 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






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






3. 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.






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






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






6. 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






7. 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






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






9. Health Information Portability and Accountability Act






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






11. 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






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






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






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






15. 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






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






17. 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.






18. 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






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






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






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






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






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






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






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






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






27. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.






28. 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






29. 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






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






31. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.






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. 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






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






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






36. 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






37. 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






38. 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






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






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






41. 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.






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






43. 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






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






45. Billing for services not performed






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






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






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






49. 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






50. 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