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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. American Medical Association






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






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 staff member who is legally responsible for the care and treatment given to a patient.






5. Health Information Portability and Accountability Act






6. A nonprofit integrated delivery system






7. Unauthorized release of information






8. 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






9. 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






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






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






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






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






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






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






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






17. 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






18. 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






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






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






21. Unauthorized release of information






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






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






24. A rule - condition - or requirement






25. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost






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






27. 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






28. A rule - condition - or requirement






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






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






31. 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






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






33. 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






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






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






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






38. 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






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






40. Medical services provided on an outpatient basis






41. A nonprofit integrated delivery system






42. 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






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






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






45. 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






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






47. 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






48. A list of the amount to be paid by an insurance company for each procedure service






49. 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






50. An intentional misrepresentation of the facts to deceive or mislead another.







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