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






2. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members






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






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






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






6. 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






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






8. Medical services provided on an outpatient basis






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






10. 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






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






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






13. A nonprofit integrated delivery system






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






15. 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.






16. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.






17. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage






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






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






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






21. 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






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






23. 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






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






25. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed






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






27. 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






28. 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






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






30. 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






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






32. 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.






33. An authorization directing the insurer to make payment directly to a provider of benefits - such as a physician or dentist - rather than to the insured






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






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






36. Unauthorized release of information






37. 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






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






39. 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






40. 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






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






42. A nonprofit integrated delivery system






43. A rule - condition - or requirement






44. 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






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






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






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






48. A physician - the majority of whose practice is devoted to internal medicine - family/general practice and pediatrics. An ob/gyn sometimes is considerd a primary care physician depending on coverage






49. 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






50. 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