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






2. Billing for services not performed






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






4. A rule - condition - or requirement






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






6. 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






7. Usually described as a comprehensive inpatient program for those who have experienced a serious illness - injury or disease but who do not require intensive hospital services. This includes infusion therapy - respiratory care - cardiac services - wou






8. 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.






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






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






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






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






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






14. 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






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






16. 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






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






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






19. 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






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






21. A rule - condition - or requirement






22. A document signed by the patient that is needed for use and disclosure of protected health information for purposes other than treatment - payment or health care operations






23. 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)






24. 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






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






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






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






28. A managed care system that allows the patient to only select from a defined panel of providers - who are reimbursed on a modified fee-for-service method






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






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






31. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.






32. 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






33. 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






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






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






37. 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






38. 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.






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






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






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






42. 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.






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






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






45. 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.






46. 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






47. 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






48. Health Information Portability and Accountability Act






49. Medical services provided on an outpatient basis






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