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






2. 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






3. 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






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






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






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






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






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






9. 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






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






11. 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






12. A nonprofit integrated delivery system






13. 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






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






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






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






17. 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






18. 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)






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






20. 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






21. Medical services provided on an outpatient basis






22. 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






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






24. Any healthcare services - that are determined by the insurance plan to be either; not generally accepted by informed healthcare professionals in the U.S. as efective in treating the condition - illness or diagnosis for which their use is proposed; or






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






26. 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






27. 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






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






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






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






31. Billing for services not performed






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






33. 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






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






35. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc






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






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






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






39. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage






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






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






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






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






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






45. An entity that transmits health information in electronic form in connection with a transaction covered by HIPAA. The covered entity may be a helath care coverage carrier such as Blue Cross - a health care clearinghouse through which claims are submi






46. 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.






47. 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






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






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






50. 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