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






2. 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






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






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






5. 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.






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






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






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






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






11. 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






12. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed






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






14. 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






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






16. Under HIPAA - regulations related to the security of electronic protected health information that - along with regulations - related to electronic transactions and code sets - privacy - and enforcement - compose the Administrative Simplification prov






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






18. 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






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






20. Unauthorized release of information






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






22. 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






23. Health Information Portability and Accountability Act






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






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 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.






27. Standards of conduct generally accepted as a moral guide for behavior.






28. 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.






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






30. Medical services provided on an outpatient basis






31. 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






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






33. Health Information Portability and Accountability Act






34. 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






35. 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






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






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






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






39. 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






40. 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






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






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






43. A nonprofit integrated delivery system






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






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






46. 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)






47. 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






48. Billing for services not performed






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






50. 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







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