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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 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






2. 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






3. Billing for services not performed






4. 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






5. 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






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






7. 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






8. 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






9. A person who protects the computer and networking systems within the practice and implements protocols such as password assignment - backup procedures - firewalls - virus protection - and contingency planning for emergencies.






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






11. 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






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






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






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






15. 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






16. 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






17. 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






18. 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






19. 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.






20. 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






21. 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






22. A patient claim is eligible for medicare and medicaid






23. A person who protects the computer and networking systems within the practice and implements protocols such as password assignment - backup procedures - firewalls - virus protection - and contingency planning for emergencies.






24. 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.






25. 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






26. 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.






27. 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






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






29. 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






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






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






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






33. Programs designed to reduce unnecessary medical services - both inpatient and outpatient






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






35. 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






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






37. An insurance plan requirement in which you or your primary care physician need to notify your insurance company in advance about certain medical procedures in order for those procedures to be considered a covered expense






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






39. Programs designed to reduce unnecessary medical services - both inpatient and outpatient






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






41. 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






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






43. 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.






44. 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






45. 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






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






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






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






49. 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.






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