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






2. 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






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






4. 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.






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






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






7. 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






8. Individually identifiable health information






9. 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






10. 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






11. Also known as out-of-network provider. A healthcare provider who has not contracted with the carrier of a health plan to be a participating provider of healthcare






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






13. A patient claim is eligible for medicare and medicaid






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

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






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






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






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






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






20. 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






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






22. 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






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






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






25. Also known as out-of-network provider. A healthcare provider who has not contracted with the carrier of a health plan to be a participating provider of healthcare






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






27. Health Information Portability and Accountability Act






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






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






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






31. 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






32. Medicare's method of paying acute care hospitals for inpatient care






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






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






35. Medical staff member who is legally responsible for the care and treatment given to a patient.






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






37. 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






38. 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.






39. 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






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






41. 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






42. 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






43. 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






44. 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






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






46. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment






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






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






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






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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