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






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






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






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. 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






6. 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






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






8. 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






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






10. 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.






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






12. Health Information Portability and Accountability Act






13. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis






14. 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






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






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






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






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






19. 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






20. American Medical Association






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






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






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






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






25. A rule - condition - or requirement






26. 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






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






29. 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






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






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






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






33. 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.






34. 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






35. Individually identifiable health information






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






37. 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.






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






39. Customs - rules of conduct - courtesy - and manners of the medical profession






40. 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






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






42. Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained.






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






44. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.






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






46. 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.






47. 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






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






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






50. 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