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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 monthly fee paid by the insured for specific medical insurance coverage






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






3. 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.






4. 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






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






6. A privileged communication that may be disclosed only with the patient's permission.






7. 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






8. Medical services provided on an outpatient basis






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






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






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






12. Billing for services not performed






13. A nonprofit integrated delivery system






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






15. 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.






16. 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






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






18. 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.






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






20. 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






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






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






23. 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






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






25. A rule - condition - or requirement






26. 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






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






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






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






30. 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






31. Programs designed to reduce unnecessary medical services - both inpatient and outpatient






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






33. Usually described as a comprehensive inpatient program for those who have experienced a serious illness - injury or disease but who do not require intensive hospital services. This includes infusion therapy - respiratory care - cardiac services - wou






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

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35. 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






36. 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






37. Individually identifiable health information






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






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






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






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






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






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






45. 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






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






47. A rule - condition - or requirement






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






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






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







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