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






2. A rule - condition - or requirement






3. Standards of conduct generally accepted as a moral guide for behavior.






4. Unauthorized release of information






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






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

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7. 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






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






9. A portion of the covered expenses that an insured individual must pay before inusrance coverage with co-insurance goes into effect. Deductibles are usually based on a calander year






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






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






12. 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






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






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. Medical staff member who is legally responsible for the care and treatment given to a patient.






16. 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






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






18. 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






19. 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






20. 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






21. 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






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






23. 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)






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






25. Medical services provided on an outpatient basis






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






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






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






29. 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






30. 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






31. American Medical Association






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






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






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






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. Medical staff member who is legally responsible for the care and treatment given to a patient.






37. 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






38. Billing for services not performed






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






40. 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.






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






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






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






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






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






46. Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained.






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






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






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






50. 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.