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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 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






2. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment






3. A provider who has contracted with the health plan to deliver medical services to covered persons. This includes hospitals - pharmacies or a physician who has contractually accepted the terms and conditions as set forth by the health plan






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






5. American Medical Association






6. 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






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






8. 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






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






10. American Medical Association






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






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






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






14. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc






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






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






17. 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






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






19. 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






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






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






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






23. 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






24. A patient claim is eligible for medicare and medicaid






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






26. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.






27. 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






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






29. 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






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






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






32. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician






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






34. 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.






35. 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






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






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






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






39. 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)






40. 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






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 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.






43. 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






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






45. 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






46. 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






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






48. Billing for services not performed






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






50. 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