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






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






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






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






5. 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






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






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






8. 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






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






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






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






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






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






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






15. A rule - condition - or requirement






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






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






18. 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






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






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






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






22. 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






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






24. 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






25. 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






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






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






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






29. 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






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






31. 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






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






33. Medical services provided on an outpatient basis






34. American Medical Association






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






36. 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






37. Health Information Portability and Accountability Act






38. 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.






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






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

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






42. 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.






43. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.






44. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.






45. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee






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






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






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






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






50. A rule - condition - or requirement