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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. Medical services provided on an outpatient basis






2. 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






3. 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






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






5. Individually identifiable health information






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






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






8. 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






9. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved






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






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






12. A rule - condition - or requirement






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






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

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






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






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 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






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






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






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






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






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






25. 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






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






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






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






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






32. 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






33. 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






34. 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)






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






36. 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






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






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






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






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






41. 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






42. 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






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

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






45. 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






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






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






48. 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






49. Unauthorized release of information






50. 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