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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 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






2. Programs designed to reduce unnecessary medical services - both inpatient and outpatient






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






4. 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






5. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc






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






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






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






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






11. 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






12. A physician who is part of am managed care plan that provides all primary health care services to members of the plan






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






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






15. 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






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






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






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






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






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






21. Medical services provided on an outpatient basis






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






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






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






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 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






27. 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






28. 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.






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

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30. 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






31. 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






32. A patient claim is eligible for medicare and medicaid






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






34. 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






35. 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






36. 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






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






38. American Medical Association






39. 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






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






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






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






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






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






45. 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






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






47. 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






48. 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






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






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