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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. 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






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






3. 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.






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






5. What the insurance company will consider paying for as defined in the contract.






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 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.






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






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






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






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






12. 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






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 - 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






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






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






17. Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained.






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






19. An individual designated ot help the provider remain in compliance by setting policies and procedures in place - and by training and managing the staff regarding HIPAA and patient rights; usually the contact person for questions and complaints.






20. 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






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






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

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






24. 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






25. 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






26. 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






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






28. 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.






29. 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






30. A nonprofit integrated delivery system






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






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






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






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






35. 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






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






37. 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






38. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.






39. A patient claim is eligible for medicare and medicaid






40. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment






41. 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






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






43. 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.






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






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






46. Coverage for the treatment obtained from a non-participating provider. Typically - it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider






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






48. 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






49. A rule - condition - or requirement






50. 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