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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. 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






2. An organization of provider sites with a contracted relationship that offer services






3. 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






4. 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






5. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.






6. 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






7. 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.






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






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






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






11. 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.






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






13. 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






14. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.






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






16. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.






17. 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






18. 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






19. 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






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






21. 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






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






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






24. 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






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. 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






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






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






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






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






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






32. 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.






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


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






35. Verbal or written agreement that gives approval to some action - situation - or statement.






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






37. Unauthorized release of information






38. 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






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






40. A rule - condition - or requirement






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






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






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






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






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






46. 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






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 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)






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






50. 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