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






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






3. Medical services provided on an outpatient basis






4. Health Information Portability and Accountability Act






5. 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






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






7. 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






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






9. 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.






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






11. 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






12. 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






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






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






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






16. 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






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






18. 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






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






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






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






22. 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






23. 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.






24. 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






25. 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






26. 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






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






28. Individually identifiable health information






29. 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






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






31. 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.






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






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






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






35. Unauthorized release of information






36. Medical services provided on an outpatient basis






37. American Medical Association






38. 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






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






40. American Medical Association






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






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






43. 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.






44. 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






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






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






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






48. 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






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