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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 term used to refer to the commonly charged or prevailing fees for health services within a geographic area






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






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






4. 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






5. 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






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






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






8. 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






9. 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)






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






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






12. 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






13. Unauthorized release of information






14. 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






15. 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






16. 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






17. Health Information Portability and Accountability Act






18. 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.






19. 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






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






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






22. Standards of conduct generally accepted as a moral guide for behavior.






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






24. 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






25. Standards of conduct generally accepted as a moral guide for behavior.






26. 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






27. 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.






28. 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






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

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30. 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






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






32. 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






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






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






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






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






37. 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






38. 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.






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






40. 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






41. 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






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






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






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






46. 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






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






48. A privileged communication that may be disclosed only with the patient's permission.






49. 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






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