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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 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






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






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






4. 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






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

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






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






8. Billing for services not performed






9. Unauthorized release of information






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






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






12. 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






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






14. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group






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






16. 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






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






18. A nonprofit integrated delivery system






19. 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






20. 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






21. American Medical Association






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






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






24. A structure for classifying outpatient services and procedures for purpose of payment






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






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






27. 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.






28. A person who protects the computer and networking systems within the practice and implements protocols such as password assignment - backup procedures - firewalls - virus protection - and contingency planning for emergencies.






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






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






31. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated






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






33. 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.






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






35. A rule - condition - or requirement






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






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






38. 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.






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






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






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






42. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated






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






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






45. 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






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






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






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






49. An entity that transmits health information in electronic form in connection with a transaction covered by HIPAA. The covered entity may be a helath care coverage carrier such as Blue Cross - a health care clearinghouse through which claims are submi






50. A patient claim is eligible for medicare and medicaid