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






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






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






4. Medical services provided on an outpatient basis






5. Standards of conduct generally accepted as a moral guide for behavior.






6. 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.






7. 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






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






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






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






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






12. American Medical Association






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






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






15. 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






16. 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






17. Health Information Portability and Accountability Act






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






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






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






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






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






23. 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






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






25. 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






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






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






28. A nonprofit integrated delivery system






29. 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






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






31. 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






32. 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






33. 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






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


35. 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






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






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






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






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






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






41. 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






42. The transmission of information between two parties to carry out financial or administrative activities related to health care.






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






44. 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)






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






46. Verbal or written agreement that gives approval to some action - situation - or statement.






47. A health insurance enrollee chooses to see an out of network provider without authorization






48. 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






49. Medical services provided on an outpatient basis






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