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






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






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






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






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






7. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).






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






9. 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.






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






11. 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






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






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






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






15. A nonprofit integrated delivery system






16. 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)






17. Billing for services not performed






18. 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.






19. 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






20. 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






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






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






23. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.






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






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






27. 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






28. 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.






29. 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






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






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






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






33. A nonprofit integrated delivery system






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






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 authorization directing the insurer to make payment directly to a provider of benefits - such as a physician or dentist - rather than to the insured






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






38. Medical services provided on an outpatient basis






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






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






42. 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






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






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






45. 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






46. 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






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






48. 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.






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






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