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






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






3. 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






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






5. A structure for classifying outpatient services and procedures for purpose of payment






6. 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






7. 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.






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






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






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






11. 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






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






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






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






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






16. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members






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






18. 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






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






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






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






22. A rule - condition - or requirement






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






24. A patient claim is eligible for medicare and medicaid






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 patient claim is eligible for medicare and medicaid






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






29. 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






30. 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






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






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






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






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






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






36. 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.






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






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






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






40. 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






41. A list of the amount to be paid by an insurance company for each procedure service






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






43. A nonprofit integrated delivery system






44. 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






45. 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)






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






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






48. 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






49. 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






50. A nonprofit integrated delivery system