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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 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






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






3. 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






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






5. 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.






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






8. Billing for services not performed






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






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






11. 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






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






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






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






15. 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






16. A patient claim is eligible for medicare and medicaid






17. 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






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






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






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






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






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






23. 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.






24. Health Information Portability and Accountability Act






25. 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






26. 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






27. Medical services provided on an outpatient basis






28. The condition of being secluded from the presence or view of others.






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






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






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






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






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






34. 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






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






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






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






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. A complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.






40. An authorization directing the insurer to make payment directly to a provider of benefits - such as a physician or dentist - rather than to the insured






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






42. 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






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






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






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






46. 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






47. 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)






48. 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






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






50. Individually identifiable health information