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






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






3. 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






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






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






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






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. 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.






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






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






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






12. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment






13. Health Information Portability and Accountability Act






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






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. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered






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






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






19. Billing for services not performed






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






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






22. 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






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






24. 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.






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






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






27. 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.






28. A patient claim is eligible for medicare and medicaid






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






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






31. 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






32. 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






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






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






35. 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






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






37. This law mandates reporting - disclosure of grievance and appeals requirements and financial standards for group life and health. Self insured plans are regulated by this law






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

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39. Individually identifiable health information






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






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






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






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






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






45. A nonprofit integrated delivery system






46. 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






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






48. 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






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






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