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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. The maximum amount a plan pays for a covered service






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






3. A document that is not required before physicians use or disclose protected health information for treatment - payment - or routine health care operations of the patient. (For other purposes - see Authorization form)






4. 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






5. 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






6. Individually identifiable health information






7. 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






8. Billing for services not performed






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






10. 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






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






12. 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






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






14. 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






15. 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






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






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






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






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






20. A document that is not required before physicians use or disclose protected health information for treatment - payment - or routine health care operations of the patient. (For other purposes - see Authorization form)






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






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






23. 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.






24. 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






25. 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






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






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






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






29. 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






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






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






32. 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






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






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






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

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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. Is the provider who renders a service to a patient






38. A person - who on behalf of the covered entity - performs or assists in the performance of a function or activity involving the use or disclosure of individually identifieable health information.






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






40. 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






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






42. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).






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






44. A patient claim is eligible for medicare and medicaid






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






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






47. 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






48. 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.






49. 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






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