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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. 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






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






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






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






7. 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






8. 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






9. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.






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






11. A physician - the majority of whose practice is devoted to internal medicine - family/general practice and pediatrics. An ob/gyn sometimes is considerd a primary care physician depending on coverage






12. 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






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






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






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






16. 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






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






18. A rule - condition - or requirement






19. 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.






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






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






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






23. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members






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






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






26. A nonprofit integrated delivery system






27. A physician - the majority of whose practice is devoted to internal medicine - family/general practice and pediatrics. An ob/gyn sometimes is considerd a primary care physician depending on coverage






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






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






30. 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






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






32. 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)






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






34. 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.






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






36. 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






37. 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






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






39. Billing for services not performed






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






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






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






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






44. 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






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






46. Medical services provided on an outpatient basis






47. 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






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






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






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