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






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






3. 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.






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






5. 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






6. A privileged communication that may be disclosed only with the patient's permission.






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






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






9. Unauthorized release of information






10. A patient claim is eligible for medicare and medicaid






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






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






13. 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






14. 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






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






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






17. 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






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






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






20. A patient claim is eligible for medicare and medicaid






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






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






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






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






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






26. 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






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






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






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






30. 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






31. American Medical Association






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






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






34. A privileged communication that may be disclosed only with the patient's permission.






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






36. 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






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






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






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






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






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






43. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.

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44. 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.






45. 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






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






47. 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






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






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






50. 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