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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. Approval or consent by a primary physician for patient referral to ancillary services and specialists






2. 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






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






4. 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






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






6. 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






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






8. 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






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






10. 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.






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






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






14. Individually identifiable health information






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






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






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






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






19. 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






20. 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






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






22. 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






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






24. 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






25. Health Information Portability and Accountability Act






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






27. 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






28. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.






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






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






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






32. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services






33. 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






34. 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






35. 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






36. 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






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






38. 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.






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






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






41. Approval or consent by a primary physician for patient referral to ancillary services and specialists






42. 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






43. 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






44. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services






45. 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






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






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






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






49. Billing for services not performed






50. 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.