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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 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






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






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






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. Health Information Portability and Accountability Act






6. 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






7. 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






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






9. 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






10. 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






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






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






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






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






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






16. 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






17. 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






18. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner






19. 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






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






21. Under HIPAA - a document given to the patient at the first visit or at enrollment explaining the individual's rights and the physician's legal duties in regard to protected health information.






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






23. 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.






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






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






26. 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






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






28. 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






29. 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






30. A rule - condition - or requirement






31. 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.






32. 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






33. 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






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






35. 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.






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

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






38. A patient claim is eligible for medicare and medicaid






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






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






41. American Medical Association






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






43. 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






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






45. 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






46. Health Information Portability and Accountability Act






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






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






49. 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






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







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