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






2. 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






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






4. 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






5. A willful act by an employee of taking possession of an employer's money






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






7. 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






8. 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






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






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






12. 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






13. 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






14. 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






15. 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






16. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc






17. Health Information Portability and Accountability Act






18. ABN billing rules permit physicians and other Part B care providers to bill beneficiaries directly when Medicare will not cover services for lack of medical necessity






19. 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






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






21. 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






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






23. 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






24. 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






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






26. 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






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






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






29. 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






30. 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






31. ABN billing rules permit physicians and other Part B care providers to bill beneficiaries directly when Medicare will not cover services for lack of medical necessity






32. 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.






33. A patient claim is eligible for medicare and medicaid






34. 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






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






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






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






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






39. 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)






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






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






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






43. 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.






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






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






46. 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






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






48. A rule - condition - or requirement






49. 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






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