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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. 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






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






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






4. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician






5. 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.






6. Individually identifiable health information






7. 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






8. Unauthorized release of information






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






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






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






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


13. 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






14. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician






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






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






17. Billing for services not performed






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






19. A nonprofit integrated delivery system






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






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






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






23. 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






24. 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






25. 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






26. 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






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






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






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






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






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






32. 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






33. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.






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






35. Unauthorized release of information






36. 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






37. 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






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






39. 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






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






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






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






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






44. 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.






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






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






47. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.






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






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






50. 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