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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 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






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






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






4. 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






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






6. 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






7. 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






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






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






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






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






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


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






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






15. 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






16. 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






17. 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






18. Unauthorized release of information






19. 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.






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






21. A patient claim is eligible for medicare and medicaid






22. 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






23. An intentional misrepresentation of the facts to deceive or mislead another.






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






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






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. 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






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






29. 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.






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






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






32. 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






33. 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






34. 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






35. A physician - the majority of whose practice is devoted to internal medicine - family/general practice and pediatrics. An ob/gyn sometimes is considerd a primary care physician depending on coverage






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






37. 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






38. 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






39. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.






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






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






42. 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)






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






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






45. A nonprofit integrated delivery system






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






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






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






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






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