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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. Is the provider who renders a service to a patient






2. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed






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






4. 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






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






6. A nonprofit integrated delivery system






7. 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.






8. Under HIPAA - a document given to the patient at the first visit or at enrollment explaining the individual's rights and the physician's legal duties in regard to protected health information.






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






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






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






12. Individually identifiable health information






13. A rule - condition - or requirement






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






16. Health Information Portability and Accountability Act






17. 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






18. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.






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






20. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis






21. 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






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






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






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. 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






26. 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






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






28. Individually identifiable health information






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






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






31. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.






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






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






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






35. 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






36. 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






37. 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






38. 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






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






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

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






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






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






44. 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






45. 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






46. 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






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






48. American Medical Association






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






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