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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 health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee






2. Integrating benefits payable under more than one health insurance.






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






4. A structure for classifying outpatient services and procedures for purpose of payment






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






6. American Medical Association






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






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






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






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






11. Billing for services not performed






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






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






14. 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.






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






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






17. 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






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






19. A document signed by the patient that is needed for use and disclosure of protected health information for purposes other than treatment - payment or health care operations






20. 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






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






22. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.






23. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO






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






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






26. A nonprofit integrated delivery system






27. A group of primary care physicians who have joined together to share the risk of providing care to their patients who are covered by a given health plan






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






29. Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained.






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






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






32. 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






33. 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






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






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






36. 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.






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






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






39. American Medical Association






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






41. 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






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






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






45. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.






46. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment






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






48. 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






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






50. 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