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






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






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






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






5. 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






6. 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






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






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






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






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






11. 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






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






13. 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






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






15. American Medical Association






16. Unauthorized release of information






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






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






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






21. 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






22. 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






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






24. 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






25. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.






26. 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






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






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






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






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






31. 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






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






33. 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






34. Health Information Portability and Accountability Act






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






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






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






38. Medical services provided on an outpatient basis






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






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






41. 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






42. 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






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






44. 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






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






46. An individual designated ot help the provider remain in compliance by setting policies and procedures in place - and by training and managing the staff regarding HIPAA and patient rights; usually the contact person for questions and complaints.






47. 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






48. 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






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






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







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