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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 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






2. Medical services provided on an outpatient basis






3. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area






4. 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






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






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






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






8. Medical staff member who is legally responsible for the care and treatment given to a patient.






9. 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






10. A health insurance enrollee chooses to see an out of network provider without authorization






11. 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






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






13. 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






14. 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






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






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






17. 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






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






19. A nonprofit integrated delivery system






20. 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.






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






22. 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






23. 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






24. Individually identifiable health information






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






26. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner






27. 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






28. 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






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






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






31. 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.






32. 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






33. 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






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






35. 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






36. 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






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






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






39. A patient claim is eligible for medicare and medicaid






40. 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






41. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.






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






43. 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






44. 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






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






46. 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






47. 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






48. Programs designed to reduce unnecessary medical services - both inpatient and outpatient






49. 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.






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