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






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






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






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






5. American Medical Association






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






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






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






9. 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






10. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment






11. 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






12. 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.






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






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






15. Unauthorized release of information






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






17. American Medical Association






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






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






20. 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.






21. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.






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. 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






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






25. Health Information Portability and Accountability Act






26. 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






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






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






29. 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






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






31. 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






32. 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






33. 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






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






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






36. 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






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






38. 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






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






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






41. 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






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






43. Individually identifiable health information






44. 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






45. An insurance plan requirement in which you or your primary care physician need to notify your insurance company in advance about certain medical procedures in order for those procedures to be considered a covered expense






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






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






48. 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






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






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