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






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






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






4. 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






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






6. 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






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






8. 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.






9. 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






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






11. 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






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






13. Individually identifiable health information






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






15. 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






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






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






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






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






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






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






22. A managed care system that allows the patient to only select from a defined panel of providers - who are reimbursed on a modified fee-for-service method






23. A rule - condition - or requirement






24. A group of primary care physicians who have joined together to share the risk of providing care to their patients who are covered by a given health plan






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






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






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






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






29. 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






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






31. 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






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






33. 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






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






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






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

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






38. 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






39. 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






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






41. 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






42. A patient claim is eligible for medicare and medicaid






43. 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






44. 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






45. 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.






46. 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






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






48. 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






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






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







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