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






2. 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






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






4. A privileged communication that may be disclosed only with the patient's permission.






5. 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






6. 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






7. 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






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






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






11. A clinic that is owned by the HMO and the physicians are employees of the HMO






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






13. 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






14. A rule - condition - or requirement






15. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO






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






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






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






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






20. 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






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






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






23. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.






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






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






26. 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






27. 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






28. 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






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






30. 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






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






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






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






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






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






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






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






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






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






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






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






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






43. 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






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






45. Approval or consent by a primary physician for patient referral to ancillary services and specialists






46. 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






47. 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.






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






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






50. 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