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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. 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






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






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






4. Individually identifiable health information






5. 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






6. 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






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






8. 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.






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






10. 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






11. 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






12. 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)






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






14. 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.






15. 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






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






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






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






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






21. A specific period of time in which employees may change insurance plans and medical groups offered by their employer and have the new insurance effective at a later date






22. 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.






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






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






25. 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.






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






27. 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






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






29. 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






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






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






32. 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.






33. 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






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






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






36. 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






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. Usually described as a comprehensive inpatient program for those who have experienced a serious illness - injury or disease but who do not require intensive hospital services. This includes infusion therapy - respiratory care - cardiac services - wou






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






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






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

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






43. 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






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 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






46. The period of time that payment for Medicare inpatient hospital benefits are available






47. American Medical Association






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






49. 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






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







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