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






2. 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






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






4. Unauthorized release of information






5. 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






6. A practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated






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






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






9. 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






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






11. 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






12. 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.






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






14. American Medical Association






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






16. 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






17. 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






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






19. 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






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






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






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






23. American Medical Association






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






25. 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)






26. 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






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






28. 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






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






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






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






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






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






34. 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






35. ABN billing rules permit physicians and other Part B care providers to bill beneficiaries directly when Medicare will not cover services for lack of medical necessity






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






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






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






39. Billing for services not performed






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






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






42. A rule - condition - or requirement






43. 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






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






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






46. 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






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






48. 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.






49. Health Information Portability and Accountability Act






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







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