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






2. 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.






3. 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






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






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






6. 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.






7. 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






8. A document that is not required before physicians use or disclose protected health information for treatment - payment - or routine health care operations of the patient. (For other purposes - see Authorization form)






9. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage






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






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






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






13. Someone who is eligible for or receiving benefits under an insurance policy or plan






14. Unauthorized release of information






15. 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






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






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






18. 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






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






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






21. 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






22. 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






23. 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






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






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






26. Coverage for the treatment obtained from a non-participating provider. Typically - it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider






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






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






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






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






31. 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






32. 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






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






34. 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






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






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






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






38. 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






39. 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






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






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






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

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43. The transmission of information between two parties to carry out financial or administrative activities related to health care.






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






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






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






47. 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






48. Billing for services not performed






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






50. 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.