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






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






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






4. A nonprofit integrated delivery system






5. 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






6. 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






7. A patient claim is eligible for medicare and medicaid






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






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






10. 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.






11. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists






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






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






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






15. 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






16. 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






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






18. 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






19. 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






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






21. 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.






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






23. 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






24. 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






25. 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






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






27. 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






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






29. 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






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






31. 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






32. 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






33. 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.






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






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






36. 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






37. A patient claim is eligible for medicare and medicaid






38. Individually identifiable health information






39. 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






40. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved






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






42. 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






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






44. 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






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






46. 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






47. Under HIPAA - regulations related to the security of electronic protected health information that - along with regulations - related to electronic transactions and code sets - privacy - and enforcement - compose the Administrative Simplification prov






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






49. Health Information Portability and Accountability Act






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







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