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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 sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered






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






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






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






5. 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






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






7. 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






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






9. 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






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






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






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






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






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






15. 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)






16. 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)






17. 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






18. 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






19. 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






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






21. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered






22. Health Information Portability and Accountability Act






23. 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






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


25. 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






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


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






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






30. 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






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






32. 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






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






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






35. 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






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






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






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






39. A rule - condition - or requirement






40. 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






41. Billing for services not performed






42. 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






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






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






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






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






47. 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






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






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






50. 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