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






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






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






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






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






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






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






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






10. Any healthcare services - that are determined by the insurance plan to be either; not generally accepted by informed healthcare professionals in the U.S. as efective in treating the condition - illness or diagnosis for which their use is proposed; or






11. 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






12. 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






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






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






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






16. American Medical Association






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






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

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






20. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group






21. 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






22. Health Information Portability and Accountability Act






23. 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






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






25. A patient claim is eligible for medicare and medicaid






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






27. 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






28. 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






29. Health Information Portability and Accountability Act






30. 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






31. 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






32. Billing for services not performed






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






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






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






36. 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






37. 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






38. 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






39. 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






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






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






42. A nonprofit integrated delivery system






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






44. 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






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






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






47. 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






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






49. Medical services provided on an outpatient basis






50. 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.