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






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






3. 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






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






5. 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






6. 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.






7. 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.






8. Unauthorized release of information






9. 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






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






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






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






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






14. 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






15. 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






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






17. Health Information Portability and Accountability Act






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






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






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






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






22. 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.






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






24. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry






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






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






27. 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






28. 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






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

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






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






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






33. 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






34. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan






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






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






37. A nonprofit integrated delivery system






38. 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






39. 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






40. Unauthorized release of information






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






42. American Medical Association






43. 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






44. 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






45. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.






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






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






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






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






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