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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. 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






2. 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






3. A patient claim is eligible for medicare and medicaid






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






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






6. American Medical Association






7. 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






8. 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






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






10. 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.






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






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






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






14. 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






15. Is the provider who renders a service to a patient






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






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






18. A clinic that is owned by the HMO and the physicians are employees of the HMO






19. Medicare's method of paying acute care hospitals for inpatient care






20. Medicare's method of paying acute care hospitals for inpatient care






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






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






23. Individually identifiable health information






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






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






26. 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






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






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






29. A managed care system that allows the patient to only select from a defined panel of providers - who are reimbursed on a modified fee-for-service method






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






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






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






33. 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






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






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






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






38. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.






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






40. A rule - condition - or requirement






41. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.






42. A nonprofit integrated delivery system






43. Is the provider who renders a service to a patient






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






45. 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






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






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






48. A patient claim is eligible for medicare and medicaid






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






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