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






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






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






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






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






6. 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






7. Billing for services not performed






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






10. 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






11. 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)






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






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






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






15. 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






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






17. 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






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






20. 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.






21. 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






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






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






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






25. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc






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






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






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






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






30. 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






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






32. The condition of being secluded from the presence or view of others.






33. The transmission of information between two parties to carry out financial or administrative activities related to health care.






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






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






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






37. 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






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






39. 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






40. Health Information Portability and Accountability Act






41. Billing for services not performed






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






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






44. Unauthorized release of information






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






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. 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






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






49. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan






50. Any healthcare services - that are determined by the insurance plan to be either; not generally accepted by informed healthcare professionals in the U.S. as efective in treating the condition - illness or diagnosis for which their use is proposed; or