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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. 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






2. Unauthorized release of information






3. Health Information Portability and Accountability Act






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






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






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






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






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






9. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.






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






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






12. Billing for services not performed






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






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






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






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






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






18. 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






19. 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






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






21. 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






22. 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






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






24. 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






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






26. Unauthorized release of information






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






28. 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






29. A monthly fee paid by the insured for specific medical insurance coverage






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






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






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






33. A patient claim is eligible for medicare and medicaid






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






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






36. 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






37. 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






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






39. 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






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






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






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






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






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






45. 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






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






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






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






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






50. 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