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






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






3. Under HIPAA - a document given to the patient at the first visit or at enrollment explaining the individual's rights and the physician's legal duties in regard to protected health information.






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

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5. American Medical Association






6. 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






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






8. 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






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






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






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






12. 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






13. 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






14. Individually identifiable health information






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






16. Unauthorized release of information






17. 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






18. 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






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






20. 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






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






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






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






24. 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






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






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






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






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






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






30. 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






31. An individual designated ot help the provider remain in compliance by setting policies and procedures in place - and by training and managing the staff regarding HIPAA and patient rights; usually the contact person for questions and complaints.






32. 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.






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






34. 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






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

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






37. 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






38. A patient claim is eligible for medicare and medicaid






39. 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






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






41. 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.






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






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






44. A list of the amount to be paid by an insurance company for each procedure service






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






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






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






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






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






50. 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