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






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






3. 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.






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






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






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






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






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






9. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis






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






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






12. 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.






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






14. A nonprofit integrated delivery system






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






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






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






18. 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






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






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






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






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






23. 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






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






25. A nonprofit integrated delivery system






26. Is the provider who renders a service to a patient






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






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






29. 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)






30. 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






31. 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






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






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






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






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






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






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






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






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

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






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






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






43. 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






44. 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






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






46. 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






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






48. A patient claim is eligible for medicare and medicaid






49. 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.






50. 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