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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 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






2. 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.






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






4. 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






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






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






7. 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






8. 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






9. 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






10. 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






11. 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)






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






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






14. 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






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. Medical services provided on an outpatient basis






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






18. 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






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






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






21. Individually identifiable health information






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






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






24. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.






25. A nonprofit integrated delivery system






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






27. A rule - condition - or requirement






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






29. 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






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

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






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






33. 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






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






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






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






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






38. Billing for services not performed






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






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






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






42. American Medical Association






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






44. 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






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






46. 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






47. 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






48. 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.






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






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