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






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






3. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved






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






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






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






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






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






9. 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






10. An entity that transmits health information in electronic form in connection with a transaction covered by HIPAA. The covered entity may be a helath care coverage carrier such as Blue Cross - a health care clearinghouse through which claims are submi






11. 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






12. 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.






13. 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






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






15. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved






16. 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






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






18. Medical services provided on an outpatient basis






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






20. 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






21. 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






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






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






24. A patient claim is eligible for medicare and medicaid






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

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26. Unauthorized release of information






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






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






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






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






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






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






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






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






35. 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






36. 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






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






38. 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.






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






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






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






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






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






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






45. 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.






46. 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






47. 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






48. A rule - condition - or requirement






49. 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.






50. Unauthorized release of information