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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. Coverage for the treatment obtained from a non-participating provider. Typically - it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider






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






3. A patient claim is eligible for medicare and medicaid






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






7. 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






8. 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






9. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).






10. 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






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






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






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






14. 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






15. 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






16. American Medical Association






17. 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






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






19. 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






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






21. 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






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






23. 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






24. Medical services provided on an outpatient basis






25. 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






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






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






28. 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






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

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






31. 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.






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






33. 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.






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






35. 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






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






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






38. A person - who on behalf of the covered entity - performs or assists in the performance of a function or activity involving the use or disclosure of individually identifieable health information.






39. Billing for services not performed






40. Coverage for the treatment obtained from a non-participating provider. Typically - it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider






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






42. 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






43. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).






44. A nonprofit integrated delivery system






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






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






47. 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






48. 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






49. A person who protects the computer and networking systems within the practice and implements protocols such as password assignment - backup procedures - firewalls - virus protection - and contingency planning for emergencies.






50. 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