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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 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






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






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






4. 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






5. 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






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






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






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






9. 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






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






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






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






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






14. 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






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






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






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






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






21. A patient claim is eligible for medicare and medicaid






22. 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






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






24. 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.






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






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






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






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






29. Unauthorized release of information






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






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






32. A rule - condition - or requirement






33. 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






34. 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






35. 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






36. 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






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






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






39. 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






40. 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






41. 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






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






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






44. 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.






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






46. 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






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. 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






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






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