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






2. 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






3. 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






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






5. Individually identifiable health information






6. Standards of conduct generally accepted as a moral guide for behavior.






7. Billing for services not performed






8. 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.






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






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






11. 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






12. 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






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






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






15. 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.






16. 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.






17. 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






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






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






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






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

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






23. 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)






24. 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






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






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






27. 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






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






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






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






31. 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.






32. A rule - condition - or requirement






33. 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






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






35. 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






36. 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






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






38. 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






39. American Medical Association






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






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






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






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






44. 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.






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






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






47. 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






48. 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






49. A nonprofit integrated delivery system






50. 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