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






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






3. 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






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






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






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






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






8. 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.






9. 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






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






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. A patient claim is eligible for medicare and medicaid






13. 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.






14. Individually identifiable health information






15. A rule - condition - or requirement






16. 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






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






18. 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






19. Billing for services not performed






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






21. 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






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






23. 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






24. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved






25. 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






26. 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






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






28. A list of the amount to be paid by an insurance company for each procedure service






29. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee






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






31. 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.






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






33. 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)






34. 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






35. 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






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






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






38. A provider who has contracted with the health plan to deliver medical services to covered persons. This includes hospitals - pharmacies or a physician who has contractually accepted the terms and conditions as set forth by the health plan






39. 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






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






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






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






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






44. Health Information Portability and Accountability Act






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






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






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






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






49. 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






50. 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







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