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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. 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






2. 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.






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






4. 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






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






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






7. 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.






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






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






10. 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






11. 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






12. 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






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






14. 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






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






16. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO






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






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






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






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






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. Health Information Portability and Accountability Act






23. Customs - rules of conduct - courtesy - and manners of the medical profession






24. A review of the need for inpatient hospital care - completed before the actual admission






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






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






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






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






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






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






31. 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.






32. 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






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






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






35. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible






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






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






38. 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






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






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






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






42. 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.






43. A nonprofit integrated delivery system






44. Billing for services not performed






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






46. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.






47. 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






48. 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






49. 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






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







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