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






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






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






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






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. Approval or consent by a primary physician for patient referral to ancillary services and specialists






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






8. Individually identifiable health information






9. 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






10. A clinic that is owned by the HMO and the physicians are employees of the HMO






11. 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.






12. 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






13. 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






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 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






16. Individually identifiable health information






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






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






19. 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






20. A rule - condition - or requirement






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






22. 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






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






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






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






26. 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






27. 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






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






29. 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






30. A review of the need for inpatient hospital care - completed before the actual admission






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






32. 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






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






35. A patient claim is eligible for medicare and medicaid






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






37. 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.






38. American Medical Association






39. 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






40. A nonprofit integrated delivery system






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






42. 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






43. A rule - condition - or requirement






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






45. 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






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






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






48. Unauthorized release of information






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






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