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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. 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






2. Medical services provided on an outpatient basis






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






4. 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






5. 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.






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






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






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






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






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






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






12. Medical services provided on an outpatient basis






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






14. 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






15. 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






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






17. 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






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






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






20. Individually identifiable health information






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






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






24. 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






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






26. American Medical Association






27. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated






28. 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






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






30. 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)






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






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






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






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






35. 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






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






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






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






39. 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.






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






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






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






43. 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






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






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






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

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48. 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






49. 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.






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