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






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






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






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






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






6. American Medical Association






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






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






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






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






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






12. 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






13. 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






14. 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.






15. 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






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






17. 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






18. 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






19. 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






20. 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






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






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






24. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment






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






26. 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






27. 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






28. 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






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






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






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






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






33. 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






34. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc






35. 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.






36. 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






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






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






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






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






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






42. 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






43. A rule - condition - or requirement






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






45. 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






46. 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






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






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






49. A nonprofit integrated delivery system






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