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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. 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






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






3. 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






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






5. 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






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






7. 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






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






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






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






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 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.






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






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

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






16. 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.






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






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






19. Individually identifiable health information






20. 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.






21. 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






22. 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






23. A provision that apples when a person is covered under more than one group medical program






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






25. 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






26. 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.






27. 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






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






29. A nonprofit integrated delivery system






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






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






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






33. 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.






34. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated






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






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






37. American Medical Association






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






39. 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






40. 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






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






42. 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






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






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






45. 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






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






47. 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






48. Billing for services not performed






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






50. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.