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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. 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






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






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 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.






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






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






7. 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






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






9. 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






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






11. 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






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






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






14. A patient claim is eligible for medicare and medicaid






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






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






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






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






19. 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






20. Medical services provided on an outpatient basis






21. Individually identifiable health information






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






23. 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






24. 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






25. A nonprofit integrated delivery system






26. 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






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






28. The amount of actual money available to the medical practice






29. 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.






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






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






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






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






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






36. 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






37. Individually identifiable health information






38. 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






39. 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.






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






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. Billing for services not performed






43. An intentional misrepresentation of the facts to deceive or mislead another.






44. 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






45. 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






46. 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.






47. A rule - condition - or requirement






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






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






50. 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