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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. The maximum amount a plan pays for a covered service






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






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

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






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






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






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






8. Individually identifiable health information






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






10. 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






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






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






13. A person who protects the computer and networking systems within the practice and implements protocols such as password assignment - backup procedures - firewalls - virus protection - and contingency planning for emergencies.






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






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






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






17. An authorization directing the insurer to make payment directly to a provider of benefits - such as a physician or dentist - rather than to the insured






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






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






21. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO






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






23. American Medical Association






24. 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.






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






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






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






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






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






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






31. 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






32. 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.






33. 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






34. 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






35. 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.






36. 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.






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






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






39. Medical services provided on an outpatient basis






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






41. 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






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






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






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






45. 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






46. A health insurance enrollee chooses to see an out of network provider without authorization






47. 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






48. Unauthorized release of information






49. Health Information Portability and Accountability Act






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