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






2. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group






3. 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






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






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






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






8. 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






9. 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






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






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






12. A rule - condition - or requirement






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






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






15. 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






16. 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






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






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






19. The most money you can expect to pay for covered expenses. Once the max out-of-pocket has been met - the health plan will pay 100% of certain covered expenses






20. 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






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






22. Integrating benefits payable under more than one health insurance.






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






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






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






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






29. Billing for services not performed






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






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






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






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






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






35. 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






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






37. 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






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






39. 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






40. 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






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






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






43. 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






44. 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






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






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






47. 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






48. 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






49. 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






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