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






2. 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






3. 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






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






5. 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






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






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






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






9. 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






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






11. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.






12. 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






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






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






15. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible






16. 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






17. Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained.






18. 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.






19. 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






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






21. 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)






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






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






24. 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






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






26. The dates of healthcare services were provided to the beneficiary






27. 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.






28. 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.






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






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






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






32. 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






33. A nonprofit integrated delivery system






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






35. 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






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






37. Medicare's method of paying acute care hospitals for inpatient care






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






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






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






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






42. 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






43. 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.






44. 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






45. 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






46. 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






47. The amount of actual money available to the medical practice






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






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






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