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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 practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated






2. 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.






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






4. 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






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






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






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






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






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. 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






11. The amount of actual money available to the medical practice






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






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






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






15. 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






16. 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






17. 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.






18. 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






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






20. 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






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






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






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






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






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






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






27. 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






28. 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






29. An organization of provider sites with a contracted relationship that offer services






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






31. The amount of actual money available to the medical practice






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






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






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






35. Medical services provided on an outpatient basis






36. 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






37. A patient claim is eligible for medicare and medicaid






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






39. 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.






40. 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






41. 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






42. A nonprofit integrated delivery system






43. 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






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






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






46. 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






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






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






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






50. 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.