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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. 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






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






3. 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






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






5. Individually identifiable health information






6. Health Information Portability and Accountability Act






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






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






9. 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






10. 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






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






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






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






14. 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






15. 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






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






17. American Medical Association






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






19. 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






20. 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.






21. 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






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






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






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






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






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






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






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






29. 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






30. An individual designated ot help the provider remain in compliance by setting policies and procedures in place - and by training and managing the staff regarding HIPAA and patient rights; usually the contact person for questions and complaints.






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






32. 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






33. 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.






34. A nonprofit integrated delivery system






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






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






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






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






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






40. 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






41. 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






42. 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






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






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






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






46. 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






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






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






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






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