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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. 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






2. 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






3. 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






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






6. 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.






7. Health Information Portability and Accountability Act






8. 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






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

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






11. 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






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






13. Billing for services not performed






14. 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






15. 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






16. 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






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






18. Medical services provided on an outpatient basis






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






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






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






22. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.






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






24. 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






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






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






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






28. 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






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






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






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






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






33. 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






34. 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






35. 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






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

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37. 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






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






39. Individually identifiable health information






40. A patient claim is eligible for medicare and medicaid






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






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






43. Under HIPAA - a document given to the patient at the first visit or at enrollment explaining the individual's rights and the physician's legal duties in regard to protected health information.






44. 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.






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






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






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






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






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