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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. 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






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






3. 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






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






5. 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.






6. 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






7. 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.






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






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






10. 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






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






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






14. 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






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






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






17. 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






18. 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)






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






20. 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






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






22. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment






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






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






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






26. 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.






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






28. Health Information Portability and Accountability Act






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






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






31. 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






32. 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






33. A rule - condition - or requirement






34. 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






35. 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.






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






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






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






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






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






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






42. 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.






43. 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






44. A rule - condition - or requirement






45. 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






46. 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






47. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered






48. A nonprofit integrated delivery system






49. Unauthorized release of information






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