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






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






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






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






5. 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






6. A rule - condition - or requirement






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






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






9. A nonprofit integrated delivery system






10. 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






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


12. 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






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






14. 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






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






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






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






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






19. Individually identifiable health information






20. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.






21. American Medical Association






22. 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.






23. 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






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






25. 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






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






27. A provider of medical or health services and any other person or organization who furnishes bills or is paid for health care in the normal course of business.






28. Medical services provided on an outpatient basis






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






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






31. A nonprofit integrated delivery system






32. 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






33. 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.






34. 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






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






36. A provision that apples when a person is covered under more than one group medical program






37. A patient claim is eligible for medicare and medicaid






38. 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






39. 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






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






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






42. 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






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






44. 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.






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






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






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






48. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment






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






50. 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